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by Smoots E

Hip Fracture

Definition

A hip fracture is a break in the thigh bone just below the hip joint. The hip joint consists of a ball at the top of the thigh bone and a rounded socket in the pelvis. Most hip fractures occur 1-2 inches below the ball portion of the hip.
Hip Fracture
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Copyright © Nucleus Medical Media, Inc.

Causes

A hip fracture is caused by a trauma to the bone. Fractures in young people with healthy bones are cause by major trauma. Fractures in older adults or people with conditions that lead to weakened bones may be caused by minor trauma.

Risk Factors

Factors that increase the risk of fracture in people with healthy bones include:
  • Motor vehicle accidents and other types of major trauma
  • Sporting activity that places excess stress on the hip—can lead to stress fractures (rare)
Women are more likely than men to fracture their hips, especially after menopause. It is more common in older adults. Other factors that increase the risk of hip fractures include:
  • Previous hip fracture or history of falling
  • Family history of fractures later in life
  • Small-boned, slender body—low body weight
Factors that can weaken bone and increase the risk of fractures include:
  • Osteoporosis —a bone-thinning condition that weakens all bones
  • Poor nutrition
  • Deficient intake or absorption of calcium and vitamin D
  • Physical inactivity
  • Smoking
  • Kidney disease
  • Cortisone or other steroids
  • Thyroid disorder
  • Low testosterone in men
  • Bone conditions such as osteomalacia—rare
  • Bone tumors—rare
Factors that increase the risk of falls that can lead to fractures include:
  • Weakness
  • Poor balance and coordination
  • Excessive alcohol use
  • Irregular heart beat or low blood pressure
  • Chronic disease or fragile health
  • Diabetes
  • Arthritis
  • Parkinson disease
  • History of stroke
  • Problems with vision
  • Heart failure
  • Mental impairments including Alzheimer disease
  • Certain medications which cause lightheadedness, drowsiness, or weakness

Symptoms

A hip fracture may cause:
  • Pain in the hip
  • Difficulty or inability to stand, walk, or move the hip
  • Abnormal appearance of the broken leg:
    • Looks shorter
    • Turns outward

Diagnosis

You will be asked about your symptoms and how the injury occurred. A physical exam will be done.
Images may be taken of your bones. This can be done with:

Treatment

Talk with your doctor about the best treatment plan for you. Options include:

Surgery

Surgery is needed for most hip fractures to make sure the hip heals properly. Surgery will also allow you to move about as you recover. However, surgery may not be appropriate for some people with small fractures or poor overall health. These fractures will be monitored as they heal with imaging tests. Traction may also be used to hold the leg in the appropriate place while the bone heals.
The type of surgery will depend on what part of the hip bone was broken, how severe the fracture was and the overall health of your bone. Surgical options include:
  • Insertion of surgical plates and screws to realign the bones and/or support the fractured area. The bone will be able to heal more securely.
  • Hip replacement—damaged areas of bone are removed and metal devices are inserted in their place. This surgery is reserved for those with severe bone injury or disease. It is more common in older adults.
Your doctor may recommend assistive devices such as wheelchair, cane, or walker for your recovery and rehabilitation.

Physical Therapy

A physical therapist will assess the hip fracture. An exercise program will be created to help recovery and to strengthen the muscles.

Prevention

Major trauma is typically caused by accidents and hard to avoid.
Talk to your doctor if you have osteoporosis or are at risk for osteoporosis. Medications, dietary changes, and weight bearing activities may help slow bone loss.
To reduce the risk of falls:
  • Ask your doctor if any of your medications may contribute to bone loss or symptoms of lightheadedness, drowsiness, or confusion.
  • Get your eyes checked regularly.
  • Clean spills and slippery areas right away.
  • Remove tripping hazards such as loose cords, rugs, and clutter.
  • Use non-slip mats in the bathtub and shower.
  • Install grab bars next to the toilet and in the shower or tub.
  • Put in handrails on both sides of stairways.
  • Walk only in well-lit rooms, stairs, and halls.
  • Keep flashlights on hand in case of a power outage.

RESOURCES

Family Doctor—American Academy of Family Physicians
http://familydoctor.org
OrthoInfo—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org

References

Hip fracture. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 1, 2015. Accessed March 10, 2015.
Hip fracture prevention. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00309. Updated January 2013. Accessed March 10, 2015.
Ly, Thuan V and Swiontkowski, Marc F Management of femoral neck fractures in young adults. Indian J Orthop. 2008 Jan-Mar; 42(1): 3–12.
van Diepen S, Majumdar SR, Bakal JA, McAlister FA, Ezekowitz JA. Heart failure is a risk factor for orthopedic fracture: a population-based analysis of 16,294 patients. Circulation. 2008;118(19):1946-52.
11/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Sennerby U, Melhus H, Gedeborg R, et al. Cardiovascular diseases and risk of hip fracture. JAMA. 2009;302(15):1666-1673.

1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Lee JS, Buzková P, Fink HA, et al. Subclinical thyroid dysfunction and incident hip fracture in older adults. Arch Intern Med. 2010;170(21):1876-1883.
4/24/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Ward RJ, Weissman BN, et al. ACR Appropriateness Criteria for acute hip pain: suspected fracture. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/AcuteHipPainSuspectedFracture.pdf. Published 2013. Accessed March 10, 2015.

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