A hip fracture is a serious injury involving a break in the upper part of the thighbone (femur). For older adults, this often occurs after a simple fall due to underlying bone weakness. Younger individuals typically sustain this injury from a high-impact event, such as a vehicle collision. Recognizing the severity of a hip fracture and understanding the immediate and long-term steps is essential. This guide provides information on what to know and do when a broken hip is suspected.
Misconceptions About Walking After a Hip Injury
The most common misconception is that a person cannot move or bear any weight if their hip is broken. While severe fractures cause total immobility, certain types, such as an impacted fracture, may allow for partial weight-bearing. In this situation, the broken bone ends are jammed tightly together, providing temporary stability. This stability can mask the injury’s severity, sometimes causing only mild pain, but the ability to walk is misleading and delays necessary medical attention.
A true hip fracture requires immediate medical intervention, even if some movement is possible. Symptoms include severe, localized pain in the groin or hip area that intensifies with any attempt to move the leg. A visible deformity is a strong indicator, often presenting as the injured leg appearing shorter than the other. The affected leg may also be rotated outward due to muscle pull on the broken bone fragments.
Immediate Emergency Response and Stabilization
If a hip fracture is suspected, the immediate action is to call emergency services. Attempting to help the injured person stand up, walk, or move them can cause the fracture fragments to shift, potentially leading to further damage. The person should be kept as still as possible and remain in the position they were found.
To prevent unnecessary movement and provide temporary comfort, use rolled-up towels or pillows to gently support the leg in its existing alignment. Monitor the person for signs of shock, such as confusion or rapid pulse. Covering the patient with a blanket can help maintain body temperature until emergency medical personnel arrive. Pain management in the pre-hospital setting is a priority, and emergency medical technicians may administer analgesia or a regional nerve block to reduce distress.
How Doctors Classify and Identify Hip Fractures
Diagnosis begins with a physical examination and is confirmed through imaging studies in the hospital. The initial diagnostic tool is typically a plain film X-ray, which reveals the location and severity of the break. If the X-ray is inconclusive but the patient cannot bear weight, a CT scan or MRI may be used. MRI is the gold standard for detecting occult, or hidden, fractures.
Doctors classify hip fractures based on their anatomical location on the proximal femur, which dictates treatment. Fractures of the femoral neck are intracapsular, meaning they occur within the joint capsule. Intertrochanteric and subtrochanteric fractures, which occur below the femoral neck, are classified as extracapsular breaks. This distinction is important because intracapsular fractures can disrupt the blood supply to the femoral head, increasing the risk of bone death.
Classification systems, such as the Garden classification, further grade the break based on the degree of displacement. For example, a Garden Type I fracture is incomplete and impacted, while a Type IV is completely displaced. This classification informs the surgical team’s decision on the most effective path for repair.
Primary Treatment Pathways
Most hip fractures require surgical intervention to ensure stability and allow for early mobilization, which leads to better outcomes. The type of surgery is determined by the fracture’s location, stability, and the patient’s overall health. Surgical fixation involves using specialized metal hardware to hold the bone fragments together while they heal.
Internal fixation is often used for stable fractures, utilizing pins, screws, or a sliding hip screw and plate system. For complex intertrochanteric or subtrochanteric fractures, an intramedullary nail—a rod inserted down the center of the bone—may be utilized. The primary goal of fixation is to preserve the patient’s natural hip joint.
When the fracture is displaced, especially in the femoral neck where blood supply is compromised, a replacement procedure is often chosen. A partial hip replacement (hemiarthroplasty) replaces only the femoral head and neck with a prosthetic implant. A total hip replacement replaces both the femoral head and the socket of the pelvis. Non-surgical management is rare, reserved only for stable, non-displaced fractures in patients too frail for surgery, requiring prolonged bed rest.