Hip Fracture

Information About Treatment of a Broken Hip

Elderly fall
Falls are a common injury that leads to a hip fracture.. Ruth Jenkinson / Getty Images

A broken hip is a common injury, especially in elderly individuals with thinning bone. In the United States, hip fractures are the most common broken bone that requires hospitalization; about 300,000 Americans are hospitalized for a hip fracture every year. A "broken hip" and a "hip fracture" mean the same thing.

Hip fractures in the elderly are most often caused by a fall, usually a seemingly insignificant fall.

In younger patients with stronger bones, more common causes of a broken hip include high-energy injuries such as car accidents or falls from a height. Hip fractures can also be caused by bone weakened from tumor or infection, a problem called a pathologic fracture.

Hip Fractures & Osteoporosis

A broken hip in the elderly can be explained primarily by weakening of the bone as a result of osteoporosis. Elderly patients with osteoporosis are at much higher risk of developing a hip fracture than someone without osteoporosis. Other risk factors associated with hip fracture are female sex, Caucasian race, slightly built individuals, and limited physical activity.

Osteoporosis is a condition that causes loss of bone mass; the composition of the bone is normal, but it is thinner than in normal individuals. With thinner, weaker bones, patients with osteoporosis are at much greater risk for developing a hip fracture from accidents such as falls.

Types of Hip Fractures

Hip fractures are generally separated into two types of fractures:

  • Femoral Neck Fractures
    A femoral neck fracture occurs when the ball of the ball-and-socket hip joint is fractured off the top of the femur. Treatment of a femoral neck fracture depends on the age of the patient and if the ball has moved out from its normal position
  • Intertrochanteric Hip Fractures
    An intertrochanteric hip fracture occurs just below the femoral neck. These fractures repaired more often than femoral neck fractures. The usual surgical treatment involves placement of a plate and screws or a rod and screws to stabilize the fractures.

Treatment of a hip fracture almost always requires surgery. In some cases, such as some stress fractures of the hip, or in patients who have severe medical problems that prevent surgical treatment, non-operative treatment may be recommended. However, most all hip fractures are treated with surgery. The type of surgery that is preferred depends on the type of fracture.

Complications After Hip Fracture

Complications are very common in patients who sustain a hip fracture. One of the most important reasons for performing surgery on patients who have a hip fracture is to help prevent these complications. By getting patients up and out of bed as soon as possible, the risk of complications including pneumonia, bed sores, and blood clots are diminished.

Mortality rates in the first year following a broken hip are around 25%, and the rates are highest in older populations. The cause of mortality following a hip fracture is often due to blood clots, pneumonia, or infection. Furthermore, only about 25% of patients who sustain a broken hip return to their preinjury level of activity.

The majority of patients who sustain a hip fracture will require prolonged specialized care, such as a long-term nursing or rehabilitation facility. About one year after a patient sustains a broken hip, mortality rates return to normal, but a patient who previously sustained a hip fracture is at higher risk of breaking their hip again.  Focused rehabilitation and strengthening are the best treatments to get people back to their preinjury level of activity.

Sources:

KJ Koval and JD Zuckerman; "Hip Fractures: I. Overview and Evaluation and Treatment of Femoral-Neck Fractures" J. Am. Acad. Ortho. Surg., May 1994; 2: 141 - 149.

KJ Koval and JD Zuckerman; "Hip Fractures: II. Evaluation and Treatment of Intertrochanteric Fractures" J. Am. Acad. Ortho. Surg., May 1994; 2: 150 - 156.

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