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Overview

Hip fracture
Hip fracture

Hip fractures are cracks or breaks in the top of the thigh bone (femur) close to the hip joint. They're usually caused by a fall or an injury to the side of the hip, but may occasionally be caused by a condition, such as cancer that weakens the hip bone.

Falls are very common in older people, especially in people aged 80 and over, who may have reduced vision or mobility and balance problems.

Hip fractures are also more common in women, who are more likely to get osteoporosis, a condition which makes bones weak and fragile.

Symptoms of a hip fracture

Symptoms of a hip fracture after a fall may include:

  • pain
  • not being able to lift, move or rotate (turn) your leg
  • not being unable to stand or put weight on your leg
  • bruising and swelling around your hip
  • your injured leg appearing shorter than your other leg
  • your injured leg turning outwards

A hip fracture will not necessarily cause bruising or prevent you from standing or walking.

When to seek medical help

If you think you've fractured your hip, you'll need to go to hospital as soon as possible. Dial 999 and ask for an ambulance.

Try not to move while you're waiting for the ambulance and make sure you keep warm.

If you've fallen, you may feel shaken or shocked, but try not to panic. Try to get someone's attention by:

  • calling out for help
  • banging on the wall or the floor
  • using your aid call button (if you have one)

Read more about what to do after a fall.

Hospital assessment

After arriving at hospital with a suspected hip fracture, your overall condition will be assessed. The doctor doing the assessment may:

  • ask how you were injured and if you had a fall
  • ask if this is the first time you've fallen (if you did fall)
  • ask about any health conditions you have
  • ask if you're taking any medicine
  • assess how much pain you feel
  • assess your mental state (if you fell and hit your head, you may be confused)
  • take your temperature
  • make sure you're not dehydrated

Depending on the outcome of your assessment, you may be given:

  • painkilling medicine
  • local anaesthetic injection near your hip
  • intravenous fluid (fluid through a needle into a vein in your arm)

The healthcare professionals treating you will make sure you're warm and comfortable. After a while, you may be moved from the emergency department to a ward, such as an orthopaedic ward.

To confirm whether your hip has been fractured, you may have imaging tests such as:

Treating a hip fracture

Surgery is usually the only treatment option for hip fractures.

The National Institute for Health and Care Excellence (NICE) recommends that someone with a hip fracture should have surgery within 48 hours of admission to hospital.

However, surgery may sometimes be delayed if the person is unwell with another condition and treating that condition first will significantly improve the outcome of their hip surgery.

In about half of all cases, a partial or complete hip replacement is needed. The other cases require surgery to fix the fracture with plates and screws or rods.

The type of surgery you will have depends on several factors, including:

  • the type of fracture (where on the femur it is)
  • your age
  • your level of mobility before the fracture
  • the condition of the bone and joint – for example, whether or not you have arthritis

Read more about treating a hip fracture.

Recovering from hip surgery

The aim after surgery is to speed up recovery to help you regain mobility.

The day after surgery, you should have a physiotherapy assessment and be given a rehabilitation programme that includes realistic goals for you to achieve during your recovery. The aim is to help you regain your mobility and independence so you can return home as soon as possible.

How long you'll need to stay in hospital will depend on your condition and mobility. It may be possible to be discharged after around 1 week, but most people need to stay in hospital for around 2 weeks.

Evidence suggests that prompt surgery and a tailored rehabilitation programme that starts as soon as possible after surgery can significantly improve a person's life, reduce the length of their hospital stay and help them recover their mobility faster.

Read more about recovering from a hip fracture.

Complications of hip surgery

Complications can arise from surgery, including:

  • infection – this requires further treatment and often further surgery
  • blood clots – these can form in the deep veins of the leg, called deep vein thrombosis (DVT), as a result of reduced movement. You can reduce your risk of DVT by wearing special stockings, doing exercises and taking medicine
  • pressure ulcers (bedsores) – these can happen on areas of skin under constant pressure from being in a chair or bed for long periods of time

Your surgeon should discuss these and any other risks with you.

Preventing hip fractures

It may be possible to prevent hip fractures by taking steps to prevent falls and by treating osteoporosis.

You can reduce your risk of falling by:

  • using walking aids, such as a walking stick
  • assessing your home for hazards, such as loose carpeting, and making it safer
  • doing exercises to improve your balance

Read more about preventing falls.

Hip protectors

Hip protectors can be used to reduce the impact of a fall and are particularly useful for preventing hip fractures in older people.

Hip protectors are padded material and plastic shields attached to specially designed underwear. The pads absorb the shock of a fall and the plastic shields divert the impact away from vulnerable areas of the hip.

In the past, one of the biggest issues with hip protectors was that many people found them uncomfortable and stopped wearing them. Modern hip protectors have tried to address this by having a more comfortable fit and additional features, such as ventilation to reduce sweating.

NICE suggests that hip protectors may be useful for older people in care homes who are considered to be at high risk of a fall. They're thought to be less effective for elderly people who remain active and live in their own home.

Read the full NICE guideline on falls: assessment and prevention of falls in older people.

The FRAX tool

The World Health Organization (WHO) has developed a fracture risk assessment tool to help predict the risk of fracture for people aged 40 to 90.

The tool is based on bone mineral density (BMD) and other risk factors such as age, sex and certain health conditons.

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Treatment

Hip fractures are usually treated in hospital with surgery.

Most people will need surgery to fix the fracture or replace all or part of their hip, ideally on the same day they're admitted to hospital, or the day after.

There are different operations, which are described below. The type of surgery you have will depend on:

  • the type of fracture you have - where in the thigh bone (femur) the fracture is
  • your age
  • how physically mobile you were before the hip fracture
  • your mental ability to take part in the post-surgery rehabilitation programme
  • the condition of the bone and joint – for example, whether or not you have arthritis

Internal fixation

Internal fixation is when pins, screws, rods or plates are used to hold the bone in place while it heals.

It tends to be used for either:

  • a fracture outside the socket of the hip joint (extracapsular fracture)
  • a fracture inside the socket of the hip joint (intracapsular fracture) – if it is stable and has not moved significantly (undisplaced)

If internal fixation is used for an intracapsular fracture, you'll have follow-up appointments over several months with X-rays to check it is healing well.

Hemiarthroplasty

Hemiarthroplasty is when the femoral head is replaced with a prosthesis (false part). The femoral head is the rounded top part of the thigh bone (femur) that sits in the hip socket.

The procedure is often the preferred option for intracapsular fractures (inside the socket of the hip joint), in someone who already had reduced mobility before the fracture.

In this type of fracture, a replacement is the preferred option.

Complete hip replacement

A complete hip replacement is an operation to replace both the socket in the hip and the rounded top part of the thigh bone (femoral head) with a prosthesis (false part).

This is a more major operation than hemiarthroplasty and isn't necessary in most patients, but may be considered if you already have a condition that affects your joints, such as arthritis, or you're very active.

Read more about hip replacement.

Pre-operative assessment

If you're in a stable condition, you'll ideally have surgery within 48 hours of arriving at hospital.

You'll have a pre-operative assessment to check your overall health and make sure you're ready for surgery.

During your assessment you'll be asked about any medications you're currently taking, and any necessary tests and investigations will be done.

You'll also have an anaesthetic assessment to decide what type of anaesthesia to use. Different types include:

  • spinal or epidural anaesthesia – used to numb the nerves in the lower half of your body so you will be awake but you will not feel anything
  • general anaesthetic – which puts you to sleep so you can't feel anything

Before surgery

Hip fractures can be very painful. During diagnosis and treatment, you should be given medicine to ease your pain. At first, pain relief is usually given through a needle into a vein in your arm (intravenously), with a local anaesthetic injection near the hip.

Surgery carries the risk of a blood clot forming in a vein, so steps will be taken to reduce this risk. For example, you may have injections of heparin, which is an anticoagulant that reduces the blood's ability to clot.

You'll continue to be monitored for blood clots during your stay in hospital. You may still need medication after you're discharged.

Your operation

The operation may take a couple of hours.

If you have any questions about your operation, ask your surgeon or another member of your care team.

After the operation, you'll begin your rehabilitation programme. This may take place in a different ward to the one where you had surgery.

Conservative treatment

Conservative treatment is the alternative to surgery. It involves a long period of bed rest and isn't often used because it can:

  • make people more unwell in the long-term
  • involve a longer stay in hospital
  • slow down recovery

However, conservative treatment may be necessary if surgery isn't possible – for example, if someone is too frail to cope with surgery, or if they did not go to hospital straight after the fracture happened and it has already started to heal.

Osteoporosis

Hip fractures often happen in people with osteoporosis (weak and fragile bones). You should be assessed for osteoporosis during your hospital stay.

If you have osteoporosis or you have a high risk of developing it, you'll be treated for this while you are in hospital.

Read more about treating osteoporosis.

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Recovery

After fracturing a hip, you'll have a tailored rehabilitation programme to help you regain your mobility and independence as soon as possible.

Prompt surgery and an effective rehabilitation programme have been proven to reduce the length of a person's hospital stay and help them to recover their mobility faster.

Multi-disciplinary team

Your rehabilitation will usually involve a multi-disciplinary team (a team of different healthcare professionals working together). The team may include:

  • physiotherapists – healthcare professionals trained in using physical methods, such as massage, manipulation and exercises, to promote healing and wellbeing. Find out more about physiotherapy
  • occupational therapists – healthcare professionals who identify problem areas in everyday life, such as dressing yourself or getting to the shops, and help you find practical solutions
  • social workers – people involved in providing social services who can advise on practical issues such as benefits and placement in a care home
  • an orthopaedic surgeon – a surgeon who specialises in conditions involving the bones and joints
  • a geriatrician – a doctor who specialises in healthcare for elderly people
  • a liaison nurse – a healthcare professional who may be involved in planning your discharge and keeping you and your family informed about the care you're receiving

Rehabilitation in hospital

A physiotherapy assessment and mobilisation, such as weight-bearing exercises, should begin the day after hip fracture surgery.

While you're in hospital, your rehabilitation may take place in:

  • an orthopaedic ward – for people with bone and joint conditions
  • a rehabilitation ward – for people undergoing rehabilitation programmes
  • a geriatric orthopaedic rehabilitation unit – for older people with orthopaedic conditions

Being discharged

How long you need to stay in hospital will depend on your condition and how soon you regain your mobility. If you're otherwise healthy, you may be able to leave hospital around 1 week after surgery.

Before you're discharged, an occupational therapist may assess your home to see whether you'll need any mobility aids fitted, such as handrails. You may also be given a walking aid, such as a walking stick or crutch.

Your GP and carer (if you have one) may be told when you're being discharged so that plans can be made to support you. After you've been discharged you may need to:

  • return to hospital for a rehabilitation appointment
  • see your GP for a follow-up appointment
  • have visits or telephone calls at home from healthcare professionals involved in your care

This will be discussed with you before you're discharged.

Rehabilitation programme

Following a hip fracture, you'll follow a rehabilitation programme that includes exercises to help improve your strength and mobility.

Your individualised programme will depend on your current level of fitness and mobility and may involve some of the following:

  • weight-bearing exercises – where your feet and legs support your weight, such as walking
  • non-weight-bearing exercises – where your feet and legs don't support your weight, such as swimming or cycling
  • treadmill exercises – such as walking at different speeds and inclines
  • intensive physical training – such as meeting with an exercise instructor three or more times a week to exercise
  • strength training and balance training exercises

It's extremely important that you follow your rehabilitation programme after a hip fracture to ensure you regain as much fitness and mobility as possible.

Age UK

Age UK, a charity for older people, has more useful information and advice about healthy bones and keeping fit.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 21/11/2019 13:52:48