Hip fracture
A break in the upper femur, often from a fall.
A hip fracture is a break in the upper portion of the femur, most commonly at the femoral neck, though it can rarely involve the femoral head. The classic presentation involves an elderly person who has sustained a low-energy fall and experiences groin pain with an inability to bear weight. The affected leg often appears shortened and is unnaturally rotated outward compared to the uninjured leg. Pain may also be felt at the knee. While most femoral neck fractures result from a fall, femoral head fractures, though rare, are more often caused by high-energy incidents such as traffic accidents. Risk factors include osteoporosis, other metabolic bone diseases like Paget’s disease or osteomalacia, elevated homocysteine levels, tobacco smoking, and metastatic cancer deposits that weaken the bone. Diagnosis is typically confirmed by X-ray, though MRI, CT scan, or bone scan may occasionally be necessary. Pain management can involve opioids or a nerve block. If the patient’s health permits, surgery is generally recommended within two days, with options including total hip replacement, hemiarthroplasty, or stabilization with screws. Treatment to prevent blood clots is standard after surgery. Complications are common: nonunion (failure to heal) is frequent in femoral neck fractures, and avascular necrosis of the femoral head occurs in about 20% of intracapsular fractures due to interrupted blood supply. Malunion, where the fracture heals in a distorted position, is very common, often leading to shortening or angular deformity. Medical complications include heart attack, stroke, chest infection, and delirium, which is extremely common in the first few days. Deep venous thrombosis and pulmonary embolism are significant risks, with fatal pulmonary embolism occurring in about 2% of cases. Urinary tract infections and pressure sores on the sacrum and heels are also concerns due to prolonged immobilization.
- type
- Medical condition
- common_cause
- Fall
- risk_factors
- Osteoporosis, medications, alcohol, metastatic cancer
- diagnosis
- X-rays, MRI, CT scan, bone scan
- treatment
- Surgery (total hip replacement, hemiarthroplasty, screws), pain management
- demographics
- More common in women; 15% of women break a hip at some point
- mortality
- About 20% risk of death in the year following fracture in older people
Lore & Background
The classic clinical presentation involves an elderly individual who has experienced a low-energy fall, resulting in groin pain and an inability to bear weight. This pain can also be felt in the supracondylar area of the knee. On physical examination, the affected leg is typically shortened and rotated outward (externally rotated) compared to the uninjured leg when the patient lies supine. This external rotation and shortening are classic signs of a displaced fracture of the femoral neck or trochanter. The fracture itself is a break in the upper part of the femur, most commonly at the femoral neck, though it can rarely occur at the femoral head. While most hip fractures result from a fall, femoral head fractures are more often caused by high-energy incidents such as traffic accidents. The affected extremity is often visibly deformed due to the pull of thigh muscles on the bone fragments, causing them to overlap and heal in a distorted position, a condition known as malunion. This can lead to leg shortening, varus or valgus deformity, and rotational malunion. Nonunion, where the fracture fails to heal, is common in femoral neck fractures. A frequent complication is avascular necrosis of the femoral head, occurring in about 20% of intracapsular fractures due to interrupted blood supply. The injury and subsequent surgery increase the risk of medical complications, including heart attack, stroke, chest infection, and thromboembolism, such as deep venous thrombosis and pulmonary embolism. Delirium is extremely common in the days following the fracture.
Reader's Guide
Hip fractures are a significant medical event, particularly in the elderly, with about 15% of women breaking a hip at some point in life. The risk of death in the year following a fracture is about 20% in older people. Diagnosis is generally by X-rays, though MRI, CT scan, or bone scan may occasionally be required. Surgery is generally recommended within two days if the person's health allows, with options including total hip replacement, hemiarthroplasty, or stabilizing the fracture with screws. Complications are common and include nonunion, avascular necrosis of the femoral head (20% in intracapsular fractures), malunion, thromboembolism (fatal pulmonary embolism incidence about 2%), delirium, urinary tract infection, and pressure sores. Risk factors include osteoporosis, metabolic bone diseases, elevated homocysteine levels, metastatic cancer, and tobacco smoking. The biomechanics of a sideways fall significantly increase fracture risk, with a 15-fold increase in elderly males and 12-fold in females.
Did You Know?
- Hip fractures are usually femoral neck fractures.
- Avascular necrosis of the femoral head occurs frequently (20%) in intracapsular hip fractures.
- Fatal pulmonary embolism may have an incidence of 2% after hip fracture.
- During a sideways fall, the chances of hip fracture see a 15-fold and 12-fold increase in elderly males and females, respectively.
Frequently Asked Questions
What is a hip fracture?
A hip fracture is a break in the upper portion of the femur, most often at the femoral neck and less frequently at the femoral head. It typically presents with hip pain during movement, a visibly shortened leg, and an inability to walk or bear weight.
What most commonly causes a hip fracture?
The overwhelming majority of hip fractures result from a fall, particularly in individuals whose bones have been weakened by osteoporosis. Additional risk factors include long-term polypharmacy, heavy alcohol use, and metastatic cancer that has spread to the bone.
How is a hip fracture diagnosed?
Physicians usually begin with plain X-rays to visualize the break, and may follow up with an MRI, CT scan, or bone scan to pin down the exact location and severity of the fracture.
What treatment options exist for a hip fracture?
Most patients require surgery, which can range from screw fixation to hemiarthroplasty or a full total hip replacement depending on the fracture pattern. Aggressive pain management is a key component of both the immediate and post-operative recovery phases.
Who is at the highest risk of suffering a hip fracture?
Women are disproportionately affected, with roughly 15% of them expected to sustain a hip fracture at some point in their lives. The combination of age-related bone density loss, multiple medications, and lifestyle factors such as alcohol use compounds that risk.
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