A hip fracture involves a break in the upper portion of the femur, or thigh bone, typically near the hip joint. This injury is recognized as a serious medical emergency that often requires immediate surgical intervention due to potential complications and severe instability. While pain usually prevents movement or weight-bearing, limited movement does not mean the injury is not severe. Most hip fractures cause excruciating pain and structural failure, making standing or walking impossible. Certain types of fractures can allow for limited, painful movement, which still requires prompt medical attention regardless of mobility.
Weight-Bearing Capacity and Fracture Types
The ability to bear weight after a hip injury depends heavily on the specific location and pattern of the break within the upper femur. Most hip fractures occur either in the femoral neck (the narrow bridge connecting the ball of the hip joint to the shaft) or in the intertrochanteric region. Since these sites are fundamental to weight transfer, a break compromises the entire structure.
Displaced Fractures
A displaced fracture occurs when the bone fragments separate and shift out of alignment, causing severe instability and intense pain. The mechanical structure of the joint is lost, making weight-bearing impossible and risking further soft tissue damage.
Non-Displaced Fractures
Conversely, non-displaced fractures or hairline cracks mean the bone is broken but the fragments remain aligned and stable. These fractures may allow for limited, painful weight-bearing because the bone’s alignment is temporarily maintained. Placing weight on a compromised bone can cause the fracture to displace suddenly, turning a simpler repair into a more complex injury. Femoral neck fractures are particularly concerning because displacement can interrupt the blood supply to the femoral head, potentially causing avascular necrosis.
Recognizing the Key Symptoms
A hip fracture is typically accompanied by telltale physical signs beyond intense pain. The most common symptom is severe, sharp pain localized in the groin or outer hip area, which intensifies with movement or pressure. This discomfort is paired with an inability to stand or place weight on the injured leg.
The body exhibits distinct physical changes due to the lack of structural support. The injured leg may appear visibly shorter than the uninjured leg, resulting from the bone segments overlapping. Furthermore, the foot and leg on the injured side often turn outward, a condition called external rotation, which is a classic sign of a severe hip injury. Swelling and bruising around the hip are also common indicators, though discoloration may take time to fully develop.
Immediate Response Protocol
When a hip fracture is suspected, the first action is to contact emergency medical services. Movement can worsen the injury by causing a non-displaced fracture to shift or by damaging surrounding nerves and blood vessels. Therefore, it is important not to attempt to move the injured person. The goal is to keep the person still and comfortable until trained personnel arrive.
If the person is conscious, they should be reassured and kept calm. While waiting for help, the person should remain lying flat on their back. If possible and without causing further pain, the injured leg can be gently supported by placing rolled blankets, towels, or pillows around it to prevent movement. The injured person should also be kept warm with a blanket to help prevent shock, especially if they are elderly.
Risks of Delaying Treatment
Delaying emergency care for a suspected hip fracture carries significant medical consequences that impact long-term recovery. One serious risk is the potential for avascular necrosis (AVN), especially with femoral neck fractures. This occurs when the blood supply to the ball of the hip joint is compromised, leading to bone tissue death and often necessitating a full hip replacement instead of a simpler repair.
Delaying surgery increases the risk of the fracture worsening; a non-displaced break may become fully displaced, complicating the procedure and recovery. Prolonged immobility while waiting for treatment significantly heightens the risk of life-threatening complications. These include deep vein thrombosis (DVT)—blood clots in the leg veins that can travel to the lungs and cause a pulmonary embolism. Extended bed rest also raises the risk of developing systemic issues such as pneumonia, urinary tract infections, and pressure sores, all contributing to a higher rate of disability and mortality.