What is it and how does it occur?
The hip is a ball-and-socket joint, connecting the thigh bone (femur) to the pelvis bone (Acetabulum). Hip fractures most commonly occur as a result of trauma. This is usually a fall or a direct blow to the hip itself. Elderly patients with Osteoporosis, especially women, have weaker bones and are more prone to hip fractures, even in the setting of relatively minimal trauma. Cancer patients and those with ongoing stress reactions of the hip are also more susceptible to hip fractures given weakening of the bone in these patients.
Pain over the outer upper thigh or in the groin is the most commonly experienced symptom. Significant discomfort with any attempt to flex or rotate the hip is also usually experienced. Patients will typically be unable to bear weight on the affected extremity, although in completely nondisplaced hip fractures, some patients may still be able to do so with pain. Patients will commonly keep the hip flexed and turned outwards (i.e. externally rotated) as this tends to be the most comfortable position.
X-ray is usually ordered and sufficient to diagnose a hip fracture. An MRI may be ordered for more subtle or incomplete fractures that are not visible on x-ray.
Nonoperative treatment may be considered for nondisplaced fractures of the pelvis or in patients who are unable to tolerate surgery, or confined to a bed or wheelchair. Surgery is usually indicated in all patients who have broken the femur bone portion of the hip, even if nondisplaced. The type of surgery performed depends on a variety of factors, with the location of the fracture and presence of hip osteoarthritis being two of the most important. The fracture is usually fixed with some combination of metal plates, rods, and screws. Sometimes a portion of the hip joint (hemiarthroplasty) or entire hip joint (total hip arthroplasty) requires replacement. Hip replacement is usually only reserved for active older patients and patients with significant preexisting hip osteoarthritis.
Recovery depends upon the type of surgery performed, yet patients can generally be weightbearing relatively quickly after surgery, followed by physical therapy designed to improve range of motion and increase strength of the supporting muscles of the hip joint. Patients will hopefully regain significant mobility by 3 months, but can continue to improve for up to 1 year. It is important to understand that hip fractures are significant injuries, and even after appropriate treatment, patients often do not regain their full ambulatory status that they enjoyed prior to breaking their hip.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.