Hip Fracture

Overview

A hip fracture is a serious injury that involves a break in the upper portion of the femur, the large bone that forms the thighbone. The term typically refers to fractures occurring in the femoral neck, the narrow section of bone just below the ball of the hip joint, or in the intertrochanteric region slightly below it. Hip fractures are among the most significant orthopedic injuries, particularly in older adults, and require prompt medical attention.

In the United States, more than 300,000 people are hospitalized for hip fractures each year, with the majority occurring in adults over age 65. However, hip fractures also affect younger patients involved in high-energy trauma such as motor vehicle accidents, falls from height, and sports injuries. As trauma surgeons with extensive experience treating injuries in demanding environments, our team understands the urgency of hip fracture care and the importance of getting patients mobile again as quickly and safely as possible.

Causes

Hip fractures result from either low-energy or high-energy mechanisms depending on the patient’s age and bone health:

• Falls — the leading cause in older adults; even a fall from standing height can fracture a hip weakened by osteoporosis
• Motor vehicle accidents — high-impact collisions can fracture the hip in patients of any age
• High-energy trauma — falls from significant height, industrial accidents, or sports collisions
• Stress fractures — repetitive loading, particularly in runners and military personnel, can lead to stress fractures in the femoral neck that may progress to a complete fracture
• Osteoporosis — reduced bone density is the single greatest risk factor for hip fractures in older adults, making bones vulnerable to fracture from minimal force

Risk factors beyond osteoporosis include advanced age, female sex, poor nutrition, physical inactivity, certain medications, and conditions that affect balance and increase fall risk.

Symptoms

Hip fracture symptoms are usually immediate and severe. Common signs include:

• Severe pain in the hip or groin — intense pain that worsens with any attempt to move the leg
• Inability to bear weight — most patients cannot stand or walk on the injured leg
• Bruising and swelling — discoloration and puffiness around the hip that may extend to the thigh
• Shortened leg — the injured leg may appear shorter than the opposite side due to the fracture displacement
• Outward rotation of the foot — the foot on the injured side often turns outward when the patient is lying down
• Stiffness — limited or no ability to move the hip joint

In some cases, particularly with stress fractures or incomplete fractures, symptoms may be less dramatic. Persistent groin or hip pain that worsens with activity should always be evaluated by a physician.

Emergency Response

If you suspect someone has fractured their hip, take the following steps:

1. Call 911 or go to the nearest emergency department — hip fractures require urgent evaluation and treatment
2. Keep the person still — do not attempt to move the injured leg or help the person stand
3. Keep them warm and comfortable — cover them with a blanket while waiting for emergency services
4. Do not give food or drink — the patient may need surgery, which requires an empty stomach

Prompt treatment is important because delays in surgical repair have been associated with increased complications. Our goal is to get patients to the operating room within 24 to 48 hours of injury when surgery is indicated.

Diagnosis

At the emergency department, the evaluation begins with a physical examination assessing pain, leg position, and the ability to move. X-rays of the hip are the first imaging study and will confirm most hip fractures. The X-ray helps classify the fracture type and degree of displacement, which directly informs the treatment plan.

In cases where X-rays appear normal but clinical suspicion remains high, an MRI or CT scan may be ordered. MRI is particularly useful for detecting stress fractures and non-displaced fractures that may not be visible on standard X-rays.

Treatment

Hip fractures are one of the orthopedic injuries where surgery is most often necessary. We believe in honest, transparent communication with our patients, and the reality is that the vast majority of hip fractures achieve better outcomes with surgical treatment. However, we evaluate every case on its own merits.

Non-Surgical Management

Conservative treatment may be considered in a limited number of situations:

• Stable, non-displaced fractures — certain impacted femoral neck fractures may heal with protected weight bearing and close monitoring
• Patients who cannot safely undergo surgery — individuals with severe medical conditions that make anesthesia and surgery too risky
• Hospice or end-of-life care — when the focus is on comfort rather than functional recovery

Non-surgical management involves strict bed rest or limited weight bearing, pain management, and prevention of complications such as blood clots and pressure sores. Patients managed conservatively require close follow-up with repeat imaging to monitor healing.

Surgical Treatment

The specific surgical approach depends on the fracture type, location, degree of displacement, patient age, and overall health:

• Internal fixation with screws or a plate and screws — used for non-displaced or minimally displaced femoral neck fractures, particularly in younger patients, to preserve the natural hip joint
• Partial hip replacement (hemiarthroplasty) — replaces the ball of the hip joint with a metal prosthesis while keeping the natural socket; commonly used for displaced femoral neck fractures in older adults
• Total hip replacement — replaces both the ball and socket of the hip joint; may be recommended for active older patients with displaced femoral neck fractures or those with pre-existing arthritis
• Intramedullary nailing or plate fixation — used for intertrochanteric fractures, where a metal rod or plate stabilizes the fracture from the inside

Surgery is typically performed under regional anesthesia (spinal or epidural) or general anesthesia, depending on the patient’s medical status and the surgeon’s recommendation.

Recovery and Rehabilitation

Recovery from a hip fracture is a gradual process that requires commitment to rehabilitation:

• Hospital stay (days 1-4) — pain management, prevention of blood clots, and beginning physical therapy, often standing and taking steps with assistance within 24 hours of surgery
• Weeks 1-6 — transition to a rehabilitation facility or home-based therapy; progressive weight bearing as tolerated with a walker or crutches
• Weeks 6-12 — continued strengthening exercises, balance training, and gradual transition from a walker to a cane
• Months 3-6 — most patients return to independent mobility, though full recovery may take up to a year

Physical therapy is the cornerstone of hip fracture recovery. Our rehabilitation programs focus on restoring strength, balance, and confidence in mobility. Early and consistent physical therapy has been shown to significantly improve outcomes and reduce the risk of complications.

Prevention

Preventing hip fractures involves addressing both bone health and fall risk:

• Bone density screening — women over 65 and men over 70 should undergo DEXA scans to assess for osteoporosis
• Calcium and vitamin D — adequate intake supports bone health; discuss supplementation with your doctor
• Weight-bearing exercise — regular walking, strength training, and balance exercises help maintain bone density and reduce fall risk
• Home safety modifications — remove tripping hazards, install grab bars, ensure adequate lighting, and use non-slip mats
• Medication review — some medications cause dizziness or drowsiness that increase fall risk; review your medications with your physician
• Vision checks — regular eye exams help ensure clear vision, reducing the likelihood of falls

If you or a loved one has sustained a hip injury, our San Diego trauma surgery team is here to provide expert, compassionate care. Contact us for a consultation or visit the nearest emergency department for acute injuries.