A hip fracture is a break in the upper quarter of the femur (thigh) bone. The extent of the break depends on the forces that are involved. The type of surgery used to treat a hip fracture is primarily based on the bones and soft tissues affected or on the level of the fracture.
You can break your hip at any age, but the great majority of hip fractures occur in people older than 65. As you age, your bones slowly lose minerals and become less dense. Gradual loss of density weakens bones and makes them more susceptible to a hip fracture.
A hip fracture is a serious injury, particularly if you're older, and complications can be life-threatening. Fortunately, surgery to repair a hip fracture is usually very effective, although recovery often requires time and patience.
Signs and symptoms of a hip fracture include:
- Immobility immediately after a fall
- Severe pain in your hip or groin
- Inability to put weight on your leg on the side of your injured hip
- Stiffness, bruising and swelling in and around your hip area
- Shorter leg on the side of your injured hip
- Turning outward of your leg on the side of your injured hip
Treatment for hip fracture often involves a combination of three approaches, including:
Surgery is almost always the best hip fracture treatment. Doctors typically use nonsurgical alternatives, such as traction, only if you have a serious illness that makes surgery too risky.
The type of surgery you have generally depends on the part of the hip that fractured, the severity of the fracture and your age. Generally, the better your health and mobility before your hip fracture, the better your chances for a complete recovery from a hip fracture.
Femoral neck fractures
Doctors repair this type of fracture by one of three methods:
- Metal screws. If, after the break, the bone is still properly aligned, your doctor may insert metal screws into the bone to hold it together while the fracture heals. This is called internal fixation. Often metal screws are placed in combination with bone nails (gamma nails) for additional stability.
- Replacement of part of the femur. If the ends of the broken bone aren't properly aligned or they've been damaged, your doctor may remove the head and neck of the femur and replace them with a metal prosthesis. This is known as hemiarthroplasty.
- Total hip replacement. This procedure involves replacing your upper femur and the socket in your pelvic bone with prostheses. Total hip replacement may be a good option if arthritis or a prior injury has damaged your joint, affecting its function prior to the fracture.
Although older age increases the likelihood that you'll need hip replacement, the most significant factors in determining whether you need this procedure are:
- The type of fracture you have
- The severity of your signs and symptoms
- Your personal risk of surgery-related problems
- Your mobility and ability to function independently before the fracture
A hip dislocation occurs when the head of the thighbone (femur) slips out of its socket in the hip bone (pelvis). In approximately 90% of patients, the thighbone is pushed out of its socket in a backwards direction (posterior dislocation). This leaves the hip in a fixed position, bent and twisted in toward the middle of the body. The thighbone can also slip out of its socket in a forward direction (anterior dislocation). If this occurs, the hip will be bent only slightly, and the leg will twist out and away from the middle of the body.
A hip dislocation is very painful. Patients are unable to move the leg and, if there is nerve damage, may not have any feeling in the foot or ankle area.
The hip is a ball-and-socket joint: the ball-shaped head of the femur fits inside a cup-shaped socket in the pelvis. The structure of a ball-and-socket joint gives it a great deal of stability and allows it to move freely. A great amount of force is required to pop the thighbone out of its socket, but that's just what happens in a hip dislocation.
Motor vehicle accidents are the most common cause of hip dislocations. (Wearing a seatbelt can greatly reduce your risk.)
Falls from a height (such as a fall from a ladder) or industrial accidents can also generate enough force to dislocate a hip.
With hip dislocations, there are often other injuries, including fractures in the pelvis and legs, back injuries, or head injuries.