Hip fracture

A hip fracture is the complete or partial breakage of the upper thighbone, known as the proximal femur. The femur’s rounded end (known as its head) sits tightly but freely in the pelvis socket. The correct functioning of this “ball-and-socket” joint is essential for human locomotion. Hip fractures can cause loss of the ability to stand and walk because of the tendency of the bone to heal in a malformed way — the result of stress that the thigh’s system of muscles exerts on the bone. Every year 300,000 Americans find themselves in hospital beds because of hip fractures.

While the injury is much more prevalent in the elderly population (because of osteoporosis), younger people have in the past 20 years been breaking their hips in increasing numbers. Women are more susceptible to hip fracture than men. According to the John Hopkins School of Hygiene and Public Health, 16 percent of white women suffer hip fractures, while only five percent of white men do. Because they suffer from osteoporosis in greater numbers, whites and Asians are more susceptible to hip fractures than are blacks and Hispanics. Without proper medical intervention and care, hip fractures can be permanently debilitating or even fatal. They can lead to blood clots, urinary tract infections and pneumonia.

Anatomy of the hip

The hip is the joint where the thighbone and the pelvic bone meet. It consists of the following:

  • The hip bones (two flat bones that contain the “socket” portion of the “ball-and-socket” hip joints)
  • The acetabulum (the socket)
  • The femoral head (the ball)
  • The femur (the thigh bone)
  • The articular capsule (connective tissue)

The hip is one of the most resilient structures in the body. However, because of the stress put on it by bearing dynamic body weight for many years (and, in older people, because of the loss of bone mass through osteoporosis), it eventually loses resiliency. The hips are in the region of the body known as the lower trunk. When the body’s lower trunk becomes compromised, many essential activities become difficult to perform.

Causes

There are many causes of hip fracture. Some causes are associated mainly with older people, some are associated mainly with younger people and some with people of all ages:

  • Intense impact – The sort of traumatic impact sustained in an automobile accident or a fall from a great height can cause hip fractures in people of any age.
  • Contact sports injuries – Players of football, soccer and rugby have been known to suffer hip fractures because of falls taken with the legs in unnatural positions (frequently with fellow players on top of them). When legs are twisted unnaturally and pressure is applied to them, there is the potential for a cracked femur.
  • Overly demanding training regimens – While hip fractures from training injuries used to be limited mostly to military personnel, in the last 20 years, as extreme physical training has become more popular, more and more civilians have been sustaining stress fractures from overexertion during physical training.
  • Falls from a normal height – Elderly people, because of bad vision, compromised balance and the side effects of medications, fall more than young people do. They may fall walking on level ground or even when standing still. Because people’s bones lose the calcium and other minerals that give them strength as the years go by, people over age 60 suffer 90 percent of all hip fractures.

Symptoms

Different types of hip fractures have different symptoms. But, generally speaking, if you have broken your hip, you will feel intense pain in your hip and groin. You will have a loss of mobility in your leg. It will bruise and swell, and it will feel stiff. Additionally, you will not be able to use the affected leg to support your own weight. 

The following are common hip fracture symptoms. Keep in mind that everyone’s body is different and will react somewhat differently to trauma:

  • Hip pain
  • Knee pain
  • Lower back pain
  • Bruised leg
  • Swollen leg
  • Twisted foot (a condition that makes the leg appear shorter)

Hip fracture symptoms may be mistaken for the symptoms of other medical conditions (a herniated intervertebral disc, spinal stenosis, a sprain, tendonitis, etc.).  Make sure you consult a doctor to determine if you have a hip fracture, and get the appropriate treatment. 

Types

Hip fractures can be divided into three main types of injury:

  • Femoral-neck fracture – The femoral neck is under the femoral head and one to two inches from the joint it makes with the acetabulum. Older people commonly get femoral neck fractures because this already relatively thin portion of the femur has been further attenuated by osteoporosis. Because a fracture of the femoral neck frequently keeps blood from flowing to the femoral head (and thus the hip joint), complications such as blood clots in the legs may result from this type of hip fracture.
  •  Intertrochanteric hip fracture – This type of fracture occurs below the femoral neck, between the greater and lesser trochanter. As an intertrochanteric hip fracture will not affect blood flow, it tends to be easier to repair and presents fewer complications than a femoral neck fracture.
  • Stress fracture – Stress fractures, which make up only about 10 percent of total hip fractures, can be harder to diagnose than the other two types. The sufferer of a stress fracture may mistake the condition for tendonitis or normal muscle soreness. This hairline fracture, which affects mostly members of the military and athletes, is caused by overexertion and repetitive motion.

The multidisciplinary team of trauma and fracture experts at Northwell Health Orthopaedic Institute treats hip fractures as well as a broad range of conditions that affect the bones.

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