A hip fracture in an elderly person is a serious injury associated with significant physical decline and an increased risk of complications. When a severe break occurs, immediate and complete immobility is expected, making the question of walking counterintuitive. However, the severity of the pain and the ability to bear weight are not always reliable indicators of a fracture. In some cases, older adults may maintain partial movement or even momentarily stand on the injured leg, which can complicate the initial diagnosis and delay necessary medical intervention.
Why Mobility Can Still Occur After a Fracture
The ability to walk after a hip injury depends on the specific type and stability of the bone break. A person may be able to bear weight if the fracture is non-displaced or “incomplete,” meaning the fragments remain aligned and wedged together. This category of injury is referred to as a stable fracture.
One common example is an impacted femoral neck fracture, where the head of the femur is driven into the neck of the bone. This impaction creates temporary stability, effectively splinting the fracture site and allowing some force transmission through the leg. The person may experience mild pain and might be able to take a few steps or stand for a short period of time.
Stable fractures mask the underlying structural damage. They may also occur in the trochanteric region of the femur, just below the neck, where the bone is wider. Even a stable subtrochanteric fracture may temporarily allow limited weight-bearing.
The danger of these hidden fractures is that they can easily become unstable. Continued weight-bearing or small, uncontrolled movements can cause the impacted fragments to shift or separate. When this displacement occurs, the fracture becomes unstable, leading to sharp, debilitating pain and the inability to move the limb.
Recognizing Hidden Symptoms of a Hip Fracture
Since mobility can be misleading, recognizing other physical signs is important to identify a hip fracture. Even if the person is able to walk, they report persistent, localized pain. This discomfort is felt deep in the groin, but it may also radiate down the thigh or be reported as knee pain.
The pain tends to intensify sharply with any attempt to rotate the hip joint. A characteristic physical sign of a hip fracture is the external rotation of the foot and leg on the injured side. The foot may appear to turn outward at an unnatural angle.
Another observable symptom is a shortening of the affected leg. This shortening is a sign of muscle spasms pulling the broken bone fragments closer together. Bruising and swelling may not be immediately apparent but can develop deep around the hip and thigh area several hours after the initial injury.
Immediate Steps and Medical Confirmation
If a hip fracture is suspected, whether the person can walk or not, the situation must be treated as a medical emergency. Call for emergency medical services. Do not attempt to move the person unless they are in immediate danger, as unnecessary movement risks displacing a stable fracture.
Medical professionals will start the diagnostic process with X-rays of the hip and pelvis. However, X-rays sometimes fail to detect hairline, or occult, fractures if the bone fragments are perfectly aligned. If X-rays are negative but the clinical suspicion remains high, further imaging is required.
Advanced Imaging
Magnetic Resonance Imaging (MRI) is considered the most reliable method for confirming the diagnosis, as it can detect the bone bruising and edema associated with a hidden fracture. Computed Tomography (CT) scans may also be used if MRI is unavailable or impractical. Prompt diagnosis is necessary because delaying treatment increases the risk of serious complications, including deep vein thrombosis (blood clots) and pneumonia.