Hip fracture

A health care provider can often diagnose a hip fracture based on symptoms and the abnormal position of the hip and leg. An X-ray usually will confirm the fracture and show where the fracture is.

If your X-ray doesn't show a fracture but you still have hip pain, your provider might order an MRI or bone scan to look for a hairline fracture.

Most hip fractures occur in one of two locations on the long bone that extends from the pelvis to your knee (femur):

• The femoral neck. This area is situated in the upper portion of your femur, just below the ball part (femoral head) of the ball-and-socket joint.
• The intertrochanteric region. This region is a little farther down from the hip joint, in the portion of the upper femur that juts outward.

Treatment for hip fracture usually involves a combination of prompt surgical repair, rehabilitation, and medication to manage pain and to prevent blood clots and infection.

Surgery

The type of surgery generally depends on where and how severe the fracture is, whether the broken bones aren't properly aligned (displaced), and your age and underlying health conditions. Options include:

• Internal repair using screws. Metal screws are inserted into the bone to hold it together while the fracture heals. Sometimes screws are attached to a metal plate that runs down the thighbone (femur).
• Total hip replacement. The upper femur and the socket in the pelvic bone are replaced with artificial parts (prostheses). Increasingly, studies show total hip replacement to be more cost-effective and associated with better long-term outcomes in otherwise healthy adults who live independently.
• Partial hip replacement. In some situations, the socket part of the hip doesn't need to be replaced. Partial hip replacement might be recommended for adults who have other health conditions or who no longer live independently.

Surgeons may recommend a full or partial hip replacement if the blood supply to the ball part of the hip joint was damaged during the fracture. That type of injury, which occurs most often in older people with femoral neck fractures, means the bone is less likely to heal properly.

Rehabilitation

Physical therapy will initially focus on range-of-motion and strengthening exercises. Depending on the type of surgery and whether there's help at home, going to an extended care facility might be necessary.

In extended care and at home, an occupational therapist teaches techniques for independence in daily life, such as using the toilet, bathing, dressing and cooking. An occupational therapist will determine if a walker or wheelchair might be needed to regain mobility and independence.

You may be referred to an orthopedic surgeon.

What to expect

Your health care provider might ask:

• Have you recently fallen or had another injury to your hip?
• How severe is your pain?
• Can you put weight on your leg on the side of your injured hip?
• Have you had a bone density test?
• Have you been diagnosed with any other medical conditions? What medications do you take, including vitamins and supplements?
• Do you use alcohol or tobacco?
• Have you ever had surgery? Were there problems?
• Do any of your blood relatives — such as a parent or sibling — have a history of bone fractures or osteoporosis?
• Do you live independently?