What is a hip fracture?

A hip fracture is a break in the bones of your hip (near the top of your leg).

How do I know if I have a hip fracture?

Hip fractures usually are caused by a fall. If you fracture your hip, you will have bad pain in your hip and you won’t be able to walk. Your hip may bruise or swell. Your leg may look shorter than usual, and it may be turned outward.

Any time you fall and are unable to get up or stand, call your doctor right away. Your doctor can check to see if you have a hip fracture. You may need an x-ray to be sure.

Who gets hip fractures?

Older people are more likely to get a hip fracture than younger people. Older people may not see as well and may have weak bones and balance problems.

How is a hip fracture treated?

Most people who have hip fractures will need surgery to make sure the leg heals the way it should.

What can I expect after surgery?

Your doctor can tell you when you should try to stand or walk after surgery. It is important to start moving as soon as possible. At first it may be hard to walk. A physical therapist can help you get stronger. You may need some help from a home nurse or from your family.

How can I prevent another hip fracture?

To help prevent a hip fracture, you should:

• Exercise regularly.

• Limit how much alcohol you drink.

• If you are a smoker, you should quit. Your doctor can help you stop smoking.

• Eat and drink more products with calcium (for example, milk, cottage cheese, yogurt, sardines, broccoli) to keep your bones strong.

• Take vitamin D each day. Your doctor can tell you how much vitamin D is safe for you.

• Use a cane or a walker to help you walk and balance.

• Get your eyes checked regularly.

• Make your house safer by moving things out of the way that you may trip over and by making sure there is plenty of light. You also can put rails along stairs and mats in the bathtub to keep you from slipping.

• Ask your doctor about medicines that can keep your bones strong and about products that can protect your hips if you fall.

The incidence of hip fracture is expected to increase as the population ages. One in five persons dies in the first year after sustaining a hip fracture, and those who survive past one year may have significant functional limitation. Although surgery is the main treatment for hip fracture, family physicians play a key role as patients’ medical consultants. Surgical repair is recommended for stable patients within 24 to 48 hours of hospitalization. Antibiotic prophylaxis is indicated to prevent infection after surgery. Thromboprophylaxis has become the standard of care for management of hip fracture.

Effective agents include unfractionated heparin, low-molecular-weight heparin, fondaparinux, and warfarin. Optimal pain control, usually with narcotic analgesics, is essential to ensure patient comfort and to facilitate rehabilitation. Rehabilitation after hip fracture surgery ideally should start on the first postoperative day with progression to ambulation as tolerated. Indwelling urinary catheters should be removed within 24 hours of surgery. Prevention, early recognition, and treatment of contributing factors for delirium also are crucial. Interventions to help prevent future falls, exercise and balance training in ambulatory patients, and the treatment of osteoporosis are important strategies for the secondary prevention of hip fracture

Of those who survive one year after hip fracture, only 40 percent can perform all routine activities of daily living and only 54 percent can walk without an aid. Although surgical repair usually is needed after hip fracture, family physicians play an important role in supporting patients through the treatment process, facilitating rehabilitation and recovery, and initiating secondary prevention strategies.

Diagnosis

A hip fracture diagnosis usually is established based on patient history, physical examination, and plain radiography. A patient with hip fracture typically presents with pain and is unable to walk after a fall. On physical examination, the injured leg is shortened, externally rotated, and abducted in the supine position. Plain radiographs of the hip (a posteroanterior view of the pelvis and a lateral view of the femur) usually confirm the diagnosis. However, when clinical suspicion for hip fracture is high and plain radiographs are normal, occult fracture should be ruled out with magnetic resonance imaging (MRI). If MRI is contraindicated, a bone scan may be useful in diagnosing fracture, but results may be normal for up to 72 hours after the injury.

Surgery

Studies have indicated that early surgery (i.e., 24 to 48 hours after hospitalization) for hip fracture is associated with lower one-year mortality, a lower incidence of pressure sores, decreased confusion,  and a lower risk of fatal pulmonary embolism (PE). However, many of these studies did not control for the presence and severity of comorbidities. Although further studies are needed to identify persons who are at a high risk for surgery because of medical conditions, the risks of early surgery may outweigh the risks of delaying surgery in patients with unstable comorbidities (e.g., congestive heart failure, unstable angina, sepsis, severe hypoxia, anemia). Delaying surgery while stabilizing these patients is reasonable; however, waiting more than 72 hours should be avoided to prevent complications from prolonged immobilization.