Hip Fracture

What is a hip fracture?

A hip fracture happens when the upper part of the thighbone (femur) breaks. The injury usually results from a fall or car accident. Hip fractures are more common in older people because bones weaken and become more brittle with age.

Most hip fractures cause severe pain and require surgery immediately. Some people need a total hip replacement after a hip fracture. Physical therapy (PT) can improve the outlook for people with hip fractures.

How common is a hip fracture?

Fractures of the hip are common. In the United States, more than 300,000 people fracture a hip every year. Risk factors for a hip fracture include:

• Age: Hip fractures are more common in people over 65. With age, bones break down, weaken and become more brittle. Older people are more likely to have problems with movement and balance, which can lead to a fall.
• Gender: Almost 75% of hip fractures happen to older women. Women lose bone mass after menopause. Weak bones are more likely to break.
• Lifestyle: People who live a sedentary lifestyle (don’t get much exercise) are more likely to fracture a hip. Drinking too much alcohol can also weaken bones and increase your fracture risk.
• Medications: Some medications increase the risk of falls. Drugs that cause drowsiness or a drop in blood pressure can cause you to lose your balance. Talk to your provider about taking these medications safely.
• Osteoporosis: This disease causes bones to become weak and porous, increasing the risk of fracture. Women are four times more likely to have osteoporosis than men.
• Overall health: People who don’t get enough vitamin D, calcium and other nutrients have a higher fracture risk. Some health conditions, such as dementia and Parkinson’s disease, increase the risk of a fall.

What part of the hip can break?

The ball-and-socket hip joint includes the upper part of the thighbone (femur) and the curved hip socket (acetabulum) of the hipbone (pelvis). The round top of the femur (the “ball,” or femoral head) fits into the hip socket to form the joint. Muscles, tendons, ligaments and soft tissues support the joint.

Hip fractures can occur in several areas of the upper femur. The most common types of hip fractures are:

• Femoral neck fracture: The neck is the area of bone just below the femoral head (ball).
• Intertrochanteric fracture: The intertrochanteric area is the part of the femur that lies between the femoral neck and the long, straight part of the femur.

What are the symptoms of a hip fracture?

Symptoms of a hip fracture typically come on suddenly. But they can appear gradually and worsen with time. Signs of a hip fracture include:

• Pain: Usually, hip pain is severe and sharp. But it can also be mild or achy. Most people feel pain in the thigh, outer hip, pelvis and groin area. Pain may radiate down your buttock to your leg (sciatica). You may also feel pain in your knee.
• Limited mobility: Most people with a hip fracture can’t stand or walk. Sometimes, it may be possible to walk, but it’s extremely painful to put weight on the leg.
• Physical changes: You may have a bruise on your hip. One of your legs may appear shorter than the other. The hip might look like it’s out of position, twisted or rotated.

What causes a hip fracture?

Most hip fractures result from an accident, such as a fall or car crash. Athletes, especially long-distance runners, can fracture a hip with repeated use (stress fracture).

In older people, hip fractures can result from a minor fall or from twisting or pivoting suddenly. People with osteoporosis can break a hip doing everyday activities such as walking or getting out of a chair.

How is a hip fracture diagnosed?

Your healthcare provider will examine the area and ask about any recent accidents or falls. To check for nerve damage (neuropathy), your provider may touch your foot or leg and ask if you feel any sensation.

To diagnose a fracture and check for damage to soft tissues, your provider orders imaging studies. These may include:

• X-ray, which uses radiation to produce images of your bones.
• MRI, an imaging test that uses a high-powered magnet to create pictures of bones and soft tissues.
• CT scan, a test that uses a computer and several X-rays to allow your provider to see detailed images of the damaged area.

Can hip fractures be treated?

Hip fracture treatment depends on your age, overall health and type of injury. Most hip fractures require surgery within a day or two after the injury. But some people aren’t healthy enough for surgery due to their age or other conditions.

Your provider will recommend the most appropriate treatment for you, which may include:

• Surgery: Most hip fractures need surgical repair. There are several hip surgery techniques. Your provider may use metal screws, nails or plates to secure the bones and keep them in place.
• Hip replacement: Depending on the type of injury, you may need a partial or total hip replacement. After hip replacement surgery, your provider may recommend that you recover in a rehabilitation facility.
• Physical therapy (PT): Your physical therapist will create a PT program to help you regain movement, flexibility and strength. If you had a hip replacement, special exercises after hip replacement surgery can significantly improve your range of motion.
• Medications: Over-the-counter and prescription pain medications can help you manage pain and reduce inflammation. If you had surgery for a hip fracture, you may receive antibiotics to reduce the risk of infection.

Can I prevent a hip fracture?

You may not be able to prevent a broken hip. But you can lower your risk of a fracture by:

• Being active: Exercise increases muscle strength and helps you prevent bone loss. Swimming, tai chi and weight-bearing exercises improve strength and balance.
• Eating right: A diet that includes vitamin D and calcium can strengthen your bones.
• Getting regular checkups: Talk to your provider about bone density tests that spot signs of osteoporosis. Your provider may recommend medications called bisphosphonates that slow bone loss and strengthen bones.
• Preventing accidents: Keep your home free from hazards (such as throw rugs) that might cause a fall. Take care when using stairs or walking in icy conditions. If you have Parkinson’s disease, talk to your provider about how to prevent falls and maintain your balance.
• Staying healthy: Maintain a healthy weight, don’t smoke and avoid drinking too much alcohol.
• Updating your eyeglasses: Vision problems can increase your risk of a fall. Get your vision checked with regular eye exams. Make sure your eyeglass and contact lens prescriptions are updated.

What is the outlook for people with hip fractures?

A hip fracture can be life-changing. Many older people don’t regain full mobility or independence after a hip fracture. Some people need a cane or walker to get around. Other people may need full-time care.

The outlook depends on several factors, including:

• Age: Older people may not heal from a fracture as quickly, and some aren’t healthy enough for surgery. Without surgery, many people stay in bed because they can’t move without pain. Long-term bed rest can lead to serious health problems, including bedsores, blood clots and pneumonia.
• Overall health: People who move soon after hip surgery have a much better prognosis. If you’re otherwise healthy, you should get up and walk around within a day or two after surgery. Moving speeds the healing process and reduces the risk of complications from bed rest.
• Type of fracture: A femoral neck fracture can cut off the blood supply to the femoral head, causing the bone to break down and die (osteonecrosis). If the injury also damaged other tissues (such as nerves or blood vessels), recovery usually takes longer.

When should I see my healthcare provider about a hip fracture?

A fractured hip is an emergency. Call your provider right away or go to the emergency room if you have signs of a hip fracture.

A note from Cleveland Clinic

A broken hip can be life-changing, especially for older people with other health conditions. Physical therapy can significantly improve outcomes for people with a hip fracture. To prevent a hip fracture, you should stay healthy, get plenty of exercise and visit your provider for regular checkups. If you have osteoporosis, talk to your provider about medications that can slow bone loss and help you avoid a fracture.

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