Hip fracture causes symptoms risks and recovery

"Hip fractures are injuries that may initially seem minor, but their impact can be significant, especially when they occur at an advanced age. Symptoms such as severe pain and difficulty moving are among the first signs of a fracture, while the causes vary, including sudden falls or osteoporosis. In this article by Dally Medical, we will explore the causes of hip fractures, the most common symptoms that indicate a fracture, and how to recover after the injury or surgery. Additionally, we will explain the potential risks associated with hip fracture surgery and how to prevent them. If you want to understand how to properly manage this injury, follow along to learn about the best treatment and prevention methods."

What is a Hip Fracture?

The hip joint is the joint that connects the femur (thigh bone) to the pelvis. This joint is crucial because it allows us to perform daily activities such as walking, running, and sitting.

A hip fracture occurs in the neck or trochanteric region of the femur, which are the parts located below the head of the femur. These fractures often occur due to a fall or significant pressure on the joint.

Who is Most at Risk for a Hip Fracture?

Elderly Individuals: The risk increases with age.
Postmenopausal Women: Due to hormonal changes that affect bone health.
Calcium and Vitamin D Deficiency: This weakens bones and makes them more prone to fractures.
Smoking and Alcohol Consumption: These habits contribute to bone weakness.
Lack of Physical Activity: Not exercising weakens muscles and bones.

Hip fractures are a major issue, especially among the elderly. In the United States, about 300,000 cases are treated annually, and the number is increasing due to the rising average life expectancy.

Can a Hip Fracture Occur Without a Strong Impact?

Yes, in cases where bones are fragile, a fracture can occur due to a minor fall or sudden movement. For example, falling while walking on a slippery surface could result in a hip fracture, even without a strong impact.

Types of Hip Fractures

Intracapsular Fracture
This occurs within the joint capsule, specifically in the neck of the femur. This type of fracture is more serious as it can affect the blood supply to the femoral head. It is divided into three types:
- Subcapital Fracture
- Transcervical Fracture
- Basicervical Fracture
Extracapsular Fracture
This occurs outside the joint capsule and typically requires easier surgical intervention. It is divided into two types:
- Intertrochanteric Fracture
  Occurs between the greater and lesser trochanter of the femur. It is very common in the elderly and tends to heal better compared to femoral neck fractures, as the blood supply is stronger here.
- Subtrochanteric Fracture
  Occurs about 5 cm below the lesser trochanter. This type requires strong fixation due to the high pressure from body weight.
Femoral Head Fracture
Often occurs due to traumatic events such as car accidents and may be accompanied by dislocation of the hip joint.
Impacted Fracture
One part of the bone is driven into another. Pain is generally less intense, but it requires specialized evaluation.
Comminuted Fracture
The bone breaks into several smaller pieces. This requires specialized surgical intervention.

What Causes Hip Fractures?

Falls or Sudden Accidents
- Falling from a height, such as from stairs or a slippery floor.
- Traumatic car accidents that cause strong impact on the hip.
- Falls are the leading cause of fractures in the elderly, especially if the person suffers from osteoporosis.
Osteoporosis
Osteoporosis weakens bones to the point where they can fracture easily even with minor injury. Older adults and postmenopausal women are more susceptible due to a drop in estrogen levels.
Bone and Joint Conditions
- Osteoarthritis: As we age, joints wear down, increasing the risk of fractures.
- Cancer: Cancer can weaken bones, making fractures more likely.
- Osteomyelitis (Bone Infection): Can cause bone weakening and increase fracture risk.
Weak Muscles and Poor Balance
Weak muscles or poor balance increases the likelihood of falls.
Obesity
Obesity places additional pressure on bones and joints, especially the hip joint. Excess weight makes the bones more prone to fractures with a minor fall or impact.
Lack of Physical Activity
Lack of exercise weakens both bones and muscles.
Genetic Factors
A family history of osteoporosis or prior fractures may increase the likelihood of a hip fracture.
Environmental and Behavioral Factors
- Medications such as corticosteroids (used for inflammation or asthma) can weaken bones over time.
- Smoking and alcohol consumption contribute to bone weakening and an increased risk of fractures.
- Vitamin D deficiency can also weaken bones.
Sports Injuries
Injuries resulting from high-impact sports like running, skiing, or intense contact sports can increase the likelihood of hip fractures.
Age
As we age, bones become more susceptible to fractures, especially with conditions like osteoporosis or other health issues. The elderly are more prone to falls due to muscle weakness and loss of balance.

Stages of Hip Fractures

Injury Stage
- Moment of Injury: A hip fracture typically occurs due to a sudden fall or incorrect movement. The injury is usually accompanied by severe pain in the hip area.
- Initial Symptoms:
  - Intense pain in the hip or thigh.
  - Swelling and bruising in the affected area.
  - Inability to move or walk due to severe pain.
  - In some cases, the leg may appear deformed, such as turning outward or shortening.
Diagnosis Stage
- Medical Examination: Once the patient arrives at the hospital, the doctor will examine the injured area. Initially, this may be a clinical exam (leg inspection), but imaging tests may be ordered to determine the type of fracture.
- Required Imaging Tests:
  - X-rays to determine the type and location of the fracture.
  - In complex cases, MRI or CT scans may be necessary to assess the extent of the fracture and its impact on surrounding tissues.
Treatment Stage (Fracture Treatment)
The treatment approach depends on the type and size of the fracture.

Surgical Treatment:
In complex fractures or if the fracture affects joint movement or blood flow to the femoral head, surgery may be required.
- Internal Fixation: Using plates and screws to hold the bones in place.
- Hip Replacement (for more severe cases): In cases where the fracture is severe, total hip replacement may be necessary.

Non-Surgical Treatment:

In some simple cases, a hip fracture can be treated using a cast or braces to stabilize the bone, especially if the fracture is uncomplicated.

Recovery Phase after Treatment:

Early Recovery (1 to 4 weeks):
Full rest is necessary, but in some cases, after surgery, the doctor may start physical therapy to move the joint.

The patient may need to use crutches or a wheelchair during this period. Pain medications are often prescribed to alleviate discomfort.
Intermediate Recovery (1 to 3 months):
After 4 to 6 weeks, the patient may begin walking with crutches. Intensive physical therapy starts to improve joint mobility and strengthen the muscles.

During this phase, the patient starts performing light exercises to avoid stiffness and enhance strength.
Final Recovery (3 to 6 months):
At this stage, most patients are able to walk without assistance and return to daily activities. Physical therapy continues to improve balance and flexibility.

Most painful symptoms disappear, though in some cases, a feeling of weakness or mild pain may persist.

Symptoms of a Hip Fracture:

Severe Pain in the Hip Area:
The pain is usually worse when the person tries to stand or walk. It may radiate down the leg or to the knee.
Inability to Stand or Walk:
Often, the injured person cannot bear weight on the affected leg.
Swelling and Bruising Around the Hip:
The skin in the affected area may turn blue or show signs of bleeding beneath the skin.
Outward Tilting of the Leg:
In some cases, the affected leg may noticeably tilt outward.
Shortening of the Affected Leg:
The injured leg may appear slightly shorter than the healthy one.
Pain Increases with Minimal Movement:
Even turning in bed or slightly raising the leg may cause severe pain.
"Cracking" Sound at the Moment of Injury:
Some patients may hear a cracking sound or feel a sensation of the bone breaking at the time of the fall.

How Long Does It Take to Recover from a Hip Fracture?

Recovery Time after Surgery:
Surgery is the primary treatment for most hip fractures, especially if the fracture is severe or unstable. Typically, the patient will need 6 to 12 weeks to recover after surgery, but full return to normal activities may take 3 to 6 months.

Recovery Phases after Surgery:
- Week 1: The patient needs complete rest and may either stay in the hospital or a rehabilitation center. Doctors will monitor the healing of the wound.
- Weeks 2 to 4: The patient starts physical therapy to improve the ability to stand and walk using crutches or assistive devices.
- Weeks 6 to 12: The patient begins to walk progressively without support, and pain begins to decrease.
- After 3 to 6 months: During this period, the patient should regain normal mobility, although some people may still experience mild pain in the limbs.
Factors Affecting Recovery Time:
- Age: Younger people recover faster than older adults. As we age, there is an increased risk of complications such as arthritis or improper bone healing.
- General Health: Patients with chronic conditions like diabetes or heart disease may recover more slowly.
- Fracture Type: Fractures requiring complex surgery or occurring in the femoral head region may take longer to recover compared to simpler fractures.
- Patient's Commitment to Physical Therapy: Following physical therapy and rehabilitation helps strengthen muscles and speed up the recovery process.
Recovery Time for Non-Surgical Cases:
If the fracture is simple and treated with a cast or braces without surgery, recovery typically takes 6 weeks to 3 months, depending on the severity of the fracture.
Physical Rehabilitation and Physical Therapy:
Physical therapy plays a significant role in accelerating recovery as it helps strengthen the muscles around the joint and restores mobility.
- Therapy typically starts in the first week after surgery or cast application and involves exercises to increase flexibility and strength.
- Light exercises begin soon after surgery, while more challenging exercises start after 3 months.
Complications That May Affect Recovery:
- Wound Infections: Surgery may result in an infection, which can delay recovery.
- Blood Clots: After prolonged rest, blood clots may form in the legs, requiring prompt treatment.
- Bone Healing Failure: In some cases, bones may not heal properly, necessitating additional surgery.

How Can You Prevent Hip Fractures?

Maintaining Bone Strength (Through Nutrition):
- Increase Calcium Intake: Calcium is essential for bone health. It's advisable to consume dairy products such as milk and cheese, and leafy green vegetables like spinach.
- Vitamin D: Vitamin D helps the body absorb calcium. Sunlight is the main source of Vitamin D, but supplements can be taken if you're in a region with limited sunlight.
- Foods Rich in Magnesium and Phosphorus: These include nuts, seeds, and whole grains.

2. Regular Exercise:
Exercise helps strengthen bones and muscles, and improves balance.

Bone-strengthening exercises such as weight lifting help increase bone density.

Balance exercises like yoga help reduce the risk of falls.

3. Fall Prevention:

Improving Balance: Balance exercises such as yoga or Pilates help strengthen balance.
Proper Footwear: Avoid slippery or uncomfortable shoes; wear shoes with non-slip soles.
Avoid Walking in the Dark: Make sure that dark areas in your home are well-lit.

4. Managing Chronic Diseases:

Treating Osteoporosis: If you have osteoporosis, medications to enhance bone density are crucial.
Managing Other Diseases: Conditions like diabetes affect the nerves and increase the risk of falls.

5. Avoid Smoking and Alcohol:

Smoking: Smoking reduces the ability of bones to absorb calcium, weakening them.
Alcohol: Alcohol affects balance and increases the risk of falls.

6. Regular Medical Check-ups:

Bone Density Testing: Important after age 50 or if you have a family history of fractures.
Periodic Doctor Visits: Regular check-ups, especially if you have chronic conditions, help maintain safety.

7. Home Safety Techniques:

Remove Obstacles: Ensure the floors at home are clear of items that could cause slips.
Good Lighting: Make sure all areas of the home are well-lit.

8. Maintain a Healthy Weight:

Reduce Excess Weight: Obesity increases pressure on joints and bones.

9. Avoid Sudden Movements:
Avoid quick or unexpected movements, especially if you are in the recovery phase from an injury or surgery.

Medications for Hip Fractures

Pain Relief Medications:
Pain relief is crucial during the early stages after injury or surgery, as patients typically experience severe pain.

Types of Pain Relievers:
- Non-opioid Analgesics:
  - Paracetamol: Used to relieve mild to moderate pain.
  - NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen and Diclofenac help reduce pain and swelling. These should be used with caution, particularly in the elderly, to avoid stomach or kidney problems.
- Opioid Analgesics:
  In cases of severe pain, doctors may prescribe opioid medications like Codeine or Morphine. These should be used cautiously to avoid addiction or dependency.
Anti-inflammatory Drugs:
If there is swelling or inflammation around the fracture, anti-inflammatory medications are used to reduce swelling and ease pain.
- NSAIDs like Ibuprofen and Naproxen are commonly prescribed but should be used carefully due to their potential side effects on the kidneys and digestive system.
Antibiotics:
If surgery is required or there is a risk of infection from an open wound during the operation, antibiotics are given to reduce the risk of post-surgical infection.
- Common antibiotics include Cefazolin or Amoxicillin.
Calcium and Vitamin D Supplements:
After a hip fracture, bones need adequate calcium and Vitamin D to heal effectively.
- Calcium Supplements: Calcium Carbonate or Calcium Citrate are often used.
- Vitamin D Supplements: Vitamin D3 helps with calcium absorption and promotes stronger bones, especially for patients with osteoporosis or Vitamin D deficiency.
Osteoporosis Medications:
If the patient has osteoporosis, the doctor may prescribe medications to increase bone density and strength.
- Bisphosphonates such as Zoledronic Acid and Risedronate are commonly prescribed.
- Bone Metabolism Modulators like Teriparatide stimulate bone formation.
- Monoclonal Antibodies such as Denosumab reduce bone resorption.
Muscle Relaxants:
After a fracture, the patient may experience muscle spasms due to muscle tension around the affected joint.
- Medications like Cyclobenzaprine or Methocarbamol can help relax muscles and alleviate spasms.
Blood Thinners:
After hip surgery, there is a risk of blood clots due to reduced mobility. To minimize this risk, blood-thinning medications are prescribed.
- Heparin is commonly administered via injection.
- Warfarin or Rivaroxaban are oral medications used to reduce the chances of clot formation.

Hip Fracture Surgery Types

Internal Fixation Surgery:
Internal fixation aims to stabilize the broken bone using metal tools such as screws or plates to speed up healing. This surgery is often used when the femoral head is not significantly affected and does not require a full hip replacement.

Types of Internal Fixation:
- Intramedullary Nails: Long nails inserted into the femur to stabilize fractures, commonly used for trochanteric or femoral neck fractures.
- Plates and Screws: Metal plates and screws are used to fix broken parts, typically for fractures in the greater trochanter or external parts of the hip joint.
- Pin Fixation: Small pins are used to stabilize fractures, particularly femoral neck or simple fractures.
Hip Replacement Surgery:
For complex fractures or severe fractures involving the femoral head, doctors may recommend a hip replacement. This surgery involves removing the fractured femoral head and replacing it with an artificial joint.

Types of Hip Replacement:
- Partial Hip Replacement: Only the femoral head is removed and replaced with an artificial joint, typically used for fractures affecting only the head of the femur.
- Total Hip Replacement: Both the femoral head and the acetabulum (hip socket) are replaced with artificial components, commonly used for severe fractures or cases of advanced arthritis or osteoarthritis.
Open Reduction and Internal Fixation (ORIF):
ORIF is a surgical procedure where the area is opened, and the bones are repositioned using internal devices such as plates and screws. This technique is used for complex or comminuted fractures.

Advantages:
- Restores bones to their correct position.
- Provides permanent fixation with metal devices.
Disadvantages:
- Increases the risk of infection due to the surgical incision.
- Longer recovery time compared to other methods.
External Fixation Surgery:
In rare cases, such as open fractures or complex fractures, external fixation is used, where metal devices are placed outside the body to stabilize the fracture from the outside.

When It's Used:
- Used for severe fractures or when there are open wounds that need stabilization without internal surgery.
- Common in fractures that are hard to reach or require temporary stabilization.
Femoral Head Resection:
If the injury to the femoral head is too severe or difficult to repair, part of the femoral head may be removed.

When It's Used:
- Used when other treatments are not feasible due to severe fractures.
Open Reduction Surgery:
In certain cases, it may be necessary to fully open the hip to reposition the bones, especially if the fracture affects soft tissue or nerve structures around the joint.

Tips for Managing a Hip Fracture:

Rest and Avoid Putting Weight on the Injured Hip:
After the injury or surgery, avoid bearing weight on the injured leg. Use crutches or a wheelchair for movement.

If surgery is performed, follow your doctor's instructions on when to start walking to avoid complications.
Follow Medical Treatment and Medication Instructions:
Adhere to the pain medications prescribed by your doctor to reduce pain and control swelling.

If surgery is performed, ensure that you take antibiotics or calcium and Vitamin D supplements to aid healing.

Monitor for side effects: If you experience abnormal symptoms such as severe pain or unusual swelling, consult your doctor immediately.
Start Physical Therapy as Soon as Permitted:
Once the doctor allows movement, begin physical therapy as soon as possible. Physical therapy helps:
- Improve hip flexibility.
- Strengthen muscles around the joint.
- Restore balance and prevent stiffness.
Therapy may include muscle-strengthening exercises and balance exercises.
Prevent Complications:
- Blood Clots: After surgery, blood clots may form due to lack of movement. Wear compression stockings or take anticoagulant medications as prescribed by the doctor.
- Infection: If the surgery involves an incision, keep the wound clean and change dressings as instructed to prevent infection.
Modify Your Surrounding Environment:
- Remove obstacles from the floor at home to prevent falls (such as excessive rugs or scattered furniture).
- Install support bars in places like the bathroom or stairs for safety.
- Ensure proper lighting in areas where movement is required, like the bathroom and hallways.
Monitor Your Diet:
Increasing your intake of calcium and Vitamin D is important for bone health and speeding up recovery. Ensure a diet rich in dairy products, leafy vegetables, and nuts.

Eat enough protein to help build muscle and repair tissues (such as meat, legumes).

Drink plenty of fluids to avoid dehydration and promote tissue healing.
Maintain a Healthy Weight:
Obesity adds pressure on the hip and joints, so maintaining a healthy weight is important to reduce excessive strain on the affected joint.

A balanced diet and light exercise after recovery can help maintain a healthy weight.
Emotional and Psychological Support:
Recovering from a hip fracture can be physically challenging and may lead to frustration or anxiety due to limited mobility.

Seek emotional support from family and friends.

Some patients may need psychological counseling to help cope with the emotional challenges during the recovery period.