Hip fractures are serious injuries that can cause multiple complications. While older adults are the most susceptible to suffering hip fractures, they can also happen to younger people in motor vehicle collisions, motorcycle crashes, truck accidents, and falls. If you believe your hip has been broken in an accident, you should seek immediate medical attention at the emergency department of your local hospital.
Symptoms of a hip fracture
If you suffer hip injuries in an accident, the following symptoms might indicate you might have broken a hip bone:
- Severe pain in your groin or hip
- Inability to walk or to get up after falling
- Not being able to put weight on your leg on the injured side
- Swelling and bruising around the hip
- Leg appearing shorter on the injured side
- Leg on the injured side turning outward
If you have any of these symptoms following an accident, you might have suffered a hip fracture and should go to the hospital for a diagnosis and prompt treatment. If you don’t promptly get a fractured hip treated, it could cause serious complications, including the following:
- Blood clots in the veins of your leg that can break off and cause a potentially fatal pulmonary embolism
- Pneumonia
- Improper union of the bone
- Muscle atrophy
- Bedsores and infections
- Death
- In some hip fractures, blood won’t properly circulate to the femoral head, which can cause femoral avascular necrosis. Necrosis occurs when the cells die because of the lack of oxygen flow and blood to the area and happens more frequently when a fracture to the femoral neck occurs.
When to See a Doctor
If you have symptoms of a hip fracture, you should go to the hospital immediately. Call for an ambulance to transport you, and don’t move while you wait. If your injury occurred in a slip and fall accident, get someone else’s attention by yelling for help or using your cell phone to call 911.
Diagnosis of a Hip Fracture
Upon your arrival at the hospital, the medical professionals will assess your overall health and condition. The doctor might ask you about your accident. If you injured your hip in a fall, they might ask you if it was the first time that you’ve fallen. If you were in a car accident, you might be asked about any blunt force trauma to your hip. You will also be asked about any medical conditions you have, whether you are taking medication, and the severity of your pain. The doctor will also check your blood pressure and temperature and check whether you are dehydrated.
The doctor might administer painkillers, inject a local anesthetic near your hip, and have the nurse set up an IV to deliver intravenous fluid. You might be moved from the emergency department to a hospital orthopedic ward and admitted to the hospital.
The doctor might perform a few different imaging tests to determine whether your hip is fractured, including the following:
- X-ray
- Magnetic resonance imaging (MRI)
- Computer tomography (CT) scan
In many cases, a doctor can diagnose a fractured hip based on the abnormal position of the leg and hip and the symptoms. They will typically order an x-ray to confirm the diagnosis and find the location of the fracture. An MRI or CT scan might be ordered if your x-ray doesn’t show a fracture so that the doctor can look to see if you have a hairline fracture.
The majority of fractures happen in the following location on the femur bone:
- Upper portion of the femur below the ball or femoral head called the femoral neck
- Upper portion of the femur a little further down in the part of the femur that extends outward called the intertrochanteric area
Treatment of Hip Fractures Following an Accident
If your doctor diagnoses a hip fracture, surgery will typically be ordered. According to the American College of Surgeons, surgery for a hip fracture should be performed within 48 hours. In a meta-analysis of studies involving more than 191,000 patients with hip fractures, researchers found that early hip surgery following a fracture had a much lower risk of patient death and the development of bed sores. Because of this, you might anticipate quickly undergoing surgery following your admission to the hospital. However, if you have another medical condition, your surgery might be delayed until that underlying condition has been treated first.
The surgery you might receive will depend on the following factors:
- Location and type of the fracture
- Your age
- Your mobility before your accident
Most people will undergo surgery to repair the fracture or to replace part or all of the hip joint on the same day of admission or within 48 hours. The types of surgeries that might be performed are described below.
Internal Fixation
Internal fixation involves the placement of plates, screws, rods, or pins to hold the fractured bones together while they heal. This type of surgery might be used if the fracture occurred outside of the hip socket or when a fracture inside of the hip socket has not been displaced and is stable.
Hemiarthroplasty
Hemiarthroplasty is a partial hip replacement in which a prosthesis is used to replace the femoral head. This is the uppermost portion of the femur that fits into the hip socket. A partial hip replacement is often used for a fracture inside of the socket in a person whose mobility was reduced before their accident.
Total Hip Replacement
A total hip replacement involves replacing the hip socket and the femoral head with a prosthesis. It might be used if you are a very active person or if you have a condition such as arthritis that affects your joints.
Anesthesia During Surgery
An anesthesiologist will assess you before surgery to determine the type of anesthesia that should be used. Some of the types that might be administered include the following:
- Epidural anesthesia – Administered in the epidural space in your lower back to numb the lower half of your body, leaving you awake during the procedure without feeling anything
- General anesthesia – Anesthesia that will cause unconsciousness so that you won’t feel or remember anything
Recovery
Before your surgery, you will be administered pain medication. Hip surgery comes with the risk of blood clots, so your doctor might give you heparin injections to try to prevent clots. You will be monitored by the medical staff to ensure you are not forming clots while you remain in the hospital and might be sent with an anti-clotting prescription when you are discharged.
Following your operation, you will need to undergo rehabilitation. Your rehabilitation program might be in a different hospital ward or a facility outside of the hospital.
Conservative Treatment for Hip Fractures
Some people who have poor overall health might not be able to undergo surgery. They might instead receive conservative treatment as a surgical alternative. However, this will involve substantial bed rest and can result in a significantly longer hospital stay, poorer outcomes, and a much longer period of recovery. In addition to being used for people who are in too poor of health to undergo surgery, conservative treatment might also be used if you waited too long to go to the hospital following your accident and hip fracture, and it has already started healing.
Rehabilitation for Hip Fractures
The day following surgery, you will receive a physiotherapy assessment. A tailored rehabilitation program will be created for you with realistic goals during your recovery. The goal of rehabilitation is to help you regain independence and mobility as soon as possible.
Rehabilitation will typically involve physical therapy to strengthen your muscles and improve the range of motion of your hip. You might need to be admitted to a skilled nursing facility during your rehabilitation if you don’t have help at home or based on the type of surgery you had. Rehabilitation will also include occupational therapy to teach you how to gain more independence with the activities of daily life, including dressing, bathing, toileting, and cooking. The therapist will determine whether you might need to use a wheelchair or walker until you regain your mobility.
The length of your hospital stay will depend on your mobility and your condition. Some people might be discharged after one week, but most will need to remain in the hospital for about two weeks.