What is a hip fracture?
A hip fracture is actually a fracture at the top of the femoral bone (Thigh bone). The top of the femoral bone (the femoral head) is formed into a smooth ball shape that fits perfectly into the hip socket on the pelvis called the acetabulum that’s why it is known as a ball-in-socket joint. The femoral head and acetabulum are surrounded by and protected by a tough capsule, strong ligaments and muscles that keep the joint flexible and durable. The term Hip fracture covers all fractures that occur in the upper quarter of the femoral bone and can also cover a fracture of the acetabulum.
Why & when a hip fracture happens?
Due to the durable structure of your hip joint the majority of hip fractures occur when the bone itself is weakened. The most common cause of weakening in the bone is osteoporosis which normally develops in older people with the very elderly and women being more at risk. Other conditions such as metabolic disease, cancer and stress injuries can also weaken the bone making it more susceptible to fractures. In these circumstances even minor injuries like mild falls, side impacts or stepping down with too much weight on one leg can result in a hip fracture. Most fractures of a normal hip happen after high force impacts like falling from a great height and landing on your feet as well as high speed car accidents.
What to do if a hip fracture is suspected after trauma?
If you suspect someone has sustained a hip fracture after any type of trauma then you must immediately call for medical help. Most people in high impact accidents may have sustain other injuries as well as a hip fracture making medical attention vital. It is important to make sure the individual is safe and comfortable without having to move them as any walking or weight bearing will be very painful. On arrival paramedics will stabilise the hip and leg, normally on a stretcher before taking the patient to accident and emergency.
What does a hip fracture feel like?
A hip fracture from trauma causes a very intense immediate sharp pain around the groin and low back. The fracture is often accompanied by swelling and bruising and aggravated by most movements this makes weight bearing and walking excruciating. Any movement of the hip muscles may increase pain levels causing many people to be unable to move the leg at all. Some people find having their leg outstretched supported with their knee and foot turned out is the most comfortable position to stay in. Patients who have underlying bone weakening may have had a long history of groin and hip pain prior to the fracture. In cases where the there is a complete break the fractured leg may appear to be slightly shorter than the other. The intense pain after a break will last for several hours which will be aggravated or prolonged by any treatment options like manipulation or traction. Post-surgery when the bone starts to heal there will be a dull continuous ache from the swelling and healing process that will last weeks to months. During the healing process the bone is trying to knit together and re-unite this stage can be quite painful and it is very important to rest through this stage to ensure that the bone reconnects properly. The soft tissue surrounding the fracture also starts to form scar tissue to bind everything together allowing the structure to try and restore its original state and function.
How will a hip fracture be diagnosed?
Patients will be taken to A&E and a full examination will be done to rule out any additional injuries. Your doctor will order an X-ray of the pelvis to confirm the diagnosis and identify the location and the extent of the fracture. Occasionally hip fractures aren’t fully visible on X-rays and in these cases an MRI or a CT scan will be ordered as this will give a more detailed view of the fractured site. Doctors will also use an MRI scan to assess whether the pain felt after trauma is coming from injury to the hip muscles, ligaments or joint capsule and not indeed from a fracture. The occurrence of a hip fracture from mild trauma may prompt doctors to investigate for any underlying bone weakening conditions.
What treatment options are available for a hip fracture?
The treatment options and healing times for hip fractures varies depending on the position and severity of the fracture and also on the complications from any additional injuries. In most cases of hip fractures surgery is almost always necessary to stabilise the fracture. Patients will initially have to rest and avoid weight bearing and will be required to use Crutches or a zimmer frame whilst recovering. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. A pelvic fracture can take anything from 8 -12 weeks to heal if not longer. Patient’s will be referred through to a physiotherapist who will provide you with exercises to strengthen your hip, low back and leg muscles to aid the healing process. Fluctuating pain levels will be experienced throughout the healing process however most of the discomfort towards the end of the healing process comes from stiffness levels. The rehabilitation exercises as well as massage and some manipulative therapies can aid in recovering your hip and low back flexibility.
There are four types of hip fracture;
The Intracapsular fracture occurs inside the joint capsule at the neck of the femoral head. The Intertrochanteric fracture happens just below the neck of the femur between the greater and lesser trochanter which are two knuckle like boney prominences at the base of the femoral head that provide muscle attachment points. The subtrochanteric fracture occurs just below the lesser trochanter and the last type is a fracture to the acetabulum (the hip socket).