Hip and Femur Fractures

The hip is a ball-and-socket joint that connects the leg to the pelvis. The femur, or thighbone, fits into the hip socket. Hip fractures in the elderly lead to functional decline and diminished quality of life.

A hip fracture is a break in the upper part of the thighbone. The most common type is a fracture of the neck of the femur. These are low-energy osteoporotic fractures found in the elderly, patients over age 65 who fall at home or in their community. Osteoporosis is commonly called brittle bone disease. Occasionally femoral neck fractures can occur in younger patients caused by high energy trauma such as a fall from a height or an auto accident.

Hip fractures may be displaced, bones not in alignment or nondisplaced, bones are in alignment. Displaced fractures tend to be more painful than nondisplaced fractures.

• Femoral neck hip fractures are very painful and require prompt emergency treatment. A majority of elderly patients also have comorbidities like stroke, diabetes, and heart disease. Delays in treatment and being bedridden can cause deterioration of the patient’s mental and physical state including delirium, blood clots, pneumonia, and bed sores. All of which leads to a difficult recovery.

Other types of hip and femur fractures include:

• Intertrochanteric fractures: These fractures occur between the trochanter and the neck of the femur. The trochanter is the large bone on the side of the hip called the femoral trochanter. Trochanteric fractures and femoral neck fractures are the most common in types of hip fractures in older adults.
• Pelvic fractures: These fractures can occur along with hip and femur fractures. Pelvic fractures are more common in high-energy trauma, such as car accidents.

Symptoms include:

• Acute pain in the hip, groin, or thigh
• Swelling or bruising in the affected area
• Inability to stand and bear weight or move the leg
• Shortening of the leg on the affected side
• Deformity of the leg on the affected side 

Usually, a hip fracture is an emergency. At the emergency room a physician or orthopedic surgeon will take a history of your injury and check for additional injuries such as an ankle fracture, and check sensation, movement, and circulation of the injured leg. They will order x-rays to evaluate the bones and an MRI to evaluate the soft tissues and detect small or incomplete fractures. A CT scan may offer additional information about the fracture.

Non-operative treatment of hip fractures is rarely indicated given the high complication rates. It is only reserved for patients who are elderly with significant medical comorbidities. Treatment in this case involves pain management.

Surgery is almost always indicated.  The goals are to control pain, restore mobility and function, restore bone alignment and healing. Surgery should be performed within 24 hours after the break. Studies report that delayed surgery increases the length of a hospital stay.

Preoperative testing will be needed to ensure the patient is medically eligible for surgery, and to address any preexisting medical conditions.

The type of surgery is determined by the type of fracture, the age and medical condition of the patient.

• Surgery to repair the fracture – When the fracture is at the femoral neck and is not displaced, the surgeon uses screws and pins to hold the fracture together while the bone heals. This procedure is indicated for elderly patients with nondisplaced fractures and for younger patients with displaced fractures and good quality bone. The goal is to preserve the natural hip.
• Joint replacement surgery – total hip replacement or hemiarthroplasty. Hemiarthroplasty is replacement of the head of the thighbone. It is used for low-demand elderly patients with displaced fractures. In patients with these injuries who can walk or have hip pain and degenerative arthritis total hip replacement will be recommended.

Recovery from a hip or femur fracture can take several months. With proper treatment, pain management and rehabilitation, most people are able to recover fully.