Hip Fractures

what is a hip fracture?

The hip joint is a ball and socket joint that consists of the ball at top of the thighbone (femur) and the hip socket in the pelvis (acetabulum).

A fracture is a term used to describe a break in a bone. A fracture can range from a hairline crack through to complete displacement of the bone.  A fracture can also be comminuted, meaning there are multiple pieces to it.

Fractures of the hip refer to a break in the top of the femur.

what are the causes?

Hip fractures are commonly caused by a fall onto the hip.  They are commonly seen in the elderly.  Some conditions such as osteoporosis, rheumatoid arthritis or cancer treatment may weaken or soften the bone increasing susceptibility to fractures. Elderly people are susceptible to trips and falls  as a result of medical conditions, medications and sometimes poor balance.

Hip fractures can be seen people of any age and other causes of hip fractures include:

  • A fall from a height
  • Motor vehicle or motor bike accident
  • Sporting injury
  • A faint or loss of consciousness

what are the symptoms?

The initial injury will cause immediate pain. Most patients are unable to walk or control the leg.  The affected the leg may appear shorter than the other side.

how are hip fractures diagnosed?

If you are experiencing any of the symptoms above following an injury to your hip, you should see your doctor or present to the emergency department immediately.

Your doctor will ask you questions about the nature of your injury and your pain.  If you lost consciousness or collapsed further questions about you medical history will be asked.

An examination of the hip and leg will be performed.

An Xray is usually performed to confirm a hip fracture. 

A CT (computed tomography) scan may be required if an x-ray does not show the fracture lines clearly or there is a concern about the cause of the fracture. Occasionally an MRI may be required. 

how are hip fractures treated?

Hip fractures generally require surgery.  The treatment of a the hip fracture is determined by its type and location. 

It is preferable to fix fractures that can be fixed.  A pin and plate (DHS) or nail (internal rod) is used in these cases. 

Some fractures are not able to be fixed.  In these cases, the blood supply to the ball part of the hip joint is damaged.  This means fixing the hip would not result in a good outcome.  In these types of hip fractures a hip replacement (partial or full) is performed. 

Ultimately the treatment of a hip fracture is determined in consultation with your doctor.

what are the potential complications of a fracture?

  • Infection and wound breakdown
  • Damage to the blood vessels and/or nerves
  • Swelling and stiffness of the hip
  • Blood clots
  • Prominence of metal work, removal of metal work
  • Failure of fixation – sometimes the bones are not strong enough to be held together with plates, screws or wires.  This will often require further surgery.
  • Nonunion – non-healing of the bone. Factors increasing the risk of nonunion include:
    • Smoking
    • Osteoporosis
    • Diabetes
    • Infection
  • Avascular Necrosis of the femoral head – this is where the blood supply to the ball part of the joint is damaged and the ball dies and starts to disintegrate.  It causes pain and disability.  If often requires a further operation.
  • Complications of THR