A fall on the hip can be a serious medical event, particularly for older adults, and often results in a fracture of the upper part of the thigh bone, known as a hip fracture. This injury frequently leads to a loss of independence and is associated with significant health risks, making immediate and appropriate action crucial. Understanding the necessary steps, from the moment of impact through long-term recovery, is the first step toward a successful outcome. This guide details the emergency response, medical diagnosis, treatment options, and the rehabilitation process.
Immediate Response and Emergency Assessment
If a fall occurs, the most important initial step is to remain still and assess the situation without attempting to stand or move the injured limb. Moving an unstable hip fracture can cause further damage to surrounding tissues or blood vessels. Check for immediate signs of a serious injury, such as severe pain in the hip or groin area, an inability to put any weight on the leg, or a noticeable shortening or outward rotation of the leg.
If a hip fracture is suspected, you or a bystander must call 911 or emergency medical services (EMS) immediately. While waiting for professional help, keep the person warm and comfortable by covering them with a blanket, if possible, and avoid giving them anything to eat or drink in case surgery is needed. A bystander should not attempt to lift, move, or adjust the person, but instead offer reassurance and monitor for signs of shock. The goal of this immediate phase is to protect the limb from further movement and ensure rapid transport to a hospital.
Medical Evaluation and Confirming the Injury
Upon arrival at the emergency room, medical staff will perform a physical examination to check for classic signs of a fracture, like tenderness, deformity, or pain with gentle movement. The diagnostic process begins with imaging, most commonly using X-rays of the hip and pelvis to visualize the bone structure and identify the fracture location.
In some cases, a fracture may be “occult,” meaning it is not visible on the initial X-rays, yet the patient still experiences significant pain. Further imaging is necessary to confirm the diagnosis, which can involve a Computed Tomography (CT) scan to better define the fracture pattern. A Magnetic Resonance Imaging (MRI) scan is highly sensitive and is often considered the best method for detecting hidden fractures or for assessing damage to surrounding soft tissues.
Surgical and Non-Surgical Repair
The majority of true hip fractures require surgical intervention to ensure proper healing and to allow for early mobility, which is important for a better overall recovery. The specific procedure depends primarily on the fracture location, the extent of the damage, and the patient’s age and overall health.
Fractures that occur outside the hip joint capsule (extracapsular fractures) are typically treated with internal fixation, where metal screws, rods, or plates are used to stabilize the bone fragments. If the fracture occurs within the joint capsule (intracapsular fracture), there is a higher risk that the blood supply to the ball of the joint is compromised.
In these situations, especially for older, less active patients, a hip replacement is often the preferred treatment. A partial hip replacement (hemiarthroplasty) replaces only the ball of the joint, while a total hip replacement replaces both the ball and the socket. For healthy, active older adults with displaced fractures, a total hip replacement may offer a better long-term functional outcome compared to internal fixation.
Long-Term Recovery and Mobility
Rehabilitation begins almost immediately after surgery, often within the first day, to prevent complications like blood clots and muscle atrophy. The post-operative phase is a sustained, multidisciplinary effort involving pain management and intensive physical and occupational therapy.
Physical therapy (PT) focuses on restoring strength, balance, and the ability to walk. Exercises are designed to help the patient safely bear weight and use assistive devices like walkers or canes. Occupational therapy (OT) concentrates on regaining the ability to perform activities of daily living (ADLs), such as dressing, bathing, and getting in and out of a chair or bed.
Functional recovery can be gradual, with many patients regaining most of their mobility and independence within six to nine months following the injury. Preventing a second fall is paramount, so home modifications are strongly recommended to minimize tripping hazards, including:
- Removing throw rugs.
- Installing grab bars in the bathroom.
- Adding handrails on staircases.
- Ensuring all walking areas are well-lit.