Hip fractures - causes, types, symptoms, investigation, treatment, prevention

A hip fracture is a serious injury, particularly in older adults, and often requires surgery. The hip is a ball-and-socket joint where the femur (thigh bone) meets the pelvis. A hip fracture can significantly impact mobility and quality of life, and it is associated with high morbidity and mortality rates in the elderly population.
Anatomy and Types of Hip Fractures
- **Femoral Neck Fracture**: Occurs just below the ball of the ball-and-socket hip joint. Common in older adults due to osteoporosis.
- **Intertrochanteric Fracture**: Occurs between the neck of the femur and a lower bony prominence called the lesser trochanter.
- **Subtrochanteric Fracture**: Occurs below the lesser trochanter, in the shaft of the femur.
Risk Factors
- **Age**: Older adults are more susceptible due to decreased bone density and increased fall risk.
- **Gender**: Women are at higher risk due to higher rates of osteoporosis.
- **Osteoporosis**: Weakens bones, making them more prone to fractures.
- **Medications**: Some medications can affect bone density or balance.
- **Other Medical Conditions**: Conditions like Parkinson’s disease, stroke, or peripheral neuropathy that affect balance and coordination.
Symptoms
- Severe pain in the hip or groin
- Inability to put weight on the injured leg
- Stiffness, bruising, and swelling in and around the hip area
- Shorter leg on the side of the injured hip
- Turning outward of the leg on the side of the injured hip
Diagnosis
- **Physical Examination**: Assessing the range of motion, pain points, and leg alignment.
- **Imaging**: X-rays are the primary tool for diagnosing hip fractures. MRI or CT scans may be used if the fracture is not visible on X-ray.
Treatment
- **Non-Surgical Treatment**: Rarely used but may include traction and physical therapy for very frail patients or those who cannot undergo surgery.
- **Surgical Treatment**: The most common approach and includes:
- **Internal Fixation**: Using metal screws or rods to hold the bones together.
- **Hemiarthroplasty**: Replacing the broken part of the femur with a metal prosthesis.
- **Total Hip Replacement**: Replacing both the socket and the femoral head with prostheses.
Rehabilitation
- **Physical Therapy**: Essential for recovery, focusing on strengthening the hip and improving mobility.
- **Occupational Therapy**: Helps patients regain independence in daily activities.
- **Fall Prevention**: Addressing factors like home safety, balance training, and reviewing medications that may affect balance.
Prevention
- **Bone Health**: Ensuring adequate intake of calcium and vitamin D, and engaging in weight-bearing exercises.
- **Fall Prevention**: Installing handrails, using non-slip mats, and improving home lighting.
- **Regular Check-Ups**: Monitoring bone density and addressing any underlying conditions that may affect balance and mobility.
Understanding hip fractures and their management is crucial for improving outcomes, especially in the elderly population. Prompt diagnosis and appropriate treatment can enhance recovery and reduce complications.