Hip Fracture | Boston Medical Center (2023)

Hip Fracture | Boston Medical Center (1)

A hip fracture is a break in the upper quarter of the femur (thigh) bone. The extent of the break depends on the forces that are involved. The type of surgery used to treat a hip fracture is primarily based on the bones and soft tissues affected or on the level of the fracture.

What causes a hip fracture?

Hip fractures most commonly occur from a fall or from a direct blow to the side of the hip.

Some medical conditions such as osteoporosis, cancer, or stress injuries can weaken the bone and make the hip more susceptible to breaking. In severe cases, it is possible for the hip to break with the patient merely standing on the leg and twisting.

What are the symptoms of a hip fracture?

The patient with a hip fracture will have pain over the outer upper thigh or in the groin. There will be pain with any attempt to flex or rotate the hip.

If the bone has been weakened by disease (such as a stress injury or cancer), the patient may notice aching in the groin or thigh area for a period of time before the break. If the bone is completely broken, the leg may appear to be shorter than the noninjured leg. The patient will often hold the injured leg in a still position with the foot and knee turned outward (external rotation).

How is a femur shaft fracture diagnosed?


Hip Fracture | Boston Medical Center (2)

A hip fracture can be diagnosed with an x-ray image of the hip and femur.

Hip Fracture | Boston Medical Center (3)

(Video) Q&A - Hip Fracture Treatment

An MRI may identify a hip fracture otherwise missed on plain X-ray.

In some cases, if the patient falls and complains of hip pain, an incomplete fracture may not be seen on a regular X-ray. In that case, magnetic resonance imaging (MRI) may be recommended. The MRI scan will usually show a hidden fracture.

If the patient is unable to have an MRI scan because of an associated medical condition, computed tomography (CT) may be obtained instead. Computed tomography, however, is not as sensitive as MRI for seeing hidden hip fractures.

What are different types of hip fractures?

In general, there are three different types of hip fractures. The type of fracture depends on what area of the upper femur is involved.

Intracapsular Fracture

Hip Fracture | Boston Medical Center (4)

These fractures occur at the level of the neck and the head of the femur, and are generally within the capsule. The capsule is the soft-tissue envelope that contains the lubricating and nourishing fluid of the hip joint itself.

Intertrochanteric Fracture

Hip Fracture | Boston Medical Center (5)

This fracture occurs between the neck of the femur and a lower bony prominence called the lesser trochanter. The lesser trochanter is an attachment point for one of the major muscles of the hip. Intertrochanteric fractures generally cross in the area between the lesser trochanter and the greater trochanter. The greater trochanter is the bump you can feel under the skin on the outside of the hip. It acts as another muscle attachment point.

Subtrochanteric Fracture

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This fracture occurs below the lesser trochanter, in a region that is between the lesser trochanter and an area approximately 2 1/2 inches below. In more complicated cases, the amount of breakage of the bone can involve more than one of these zones. This is taken into consideration when surgical repair is considered.

(Video) Your guide through the hip fracture pathway, part 1

How is a hip fracture treated?

Once the hip fracture has been diagnosed, the patient's overall health and medical condition will be evaluated. In very rare cases, the patient may be so ill that surgery would not be recommended. In these cases, the patient's overall comfort and level of pain must be weighed against the risks of anesthesia and surgery.

Most surgeons agree that patients do better if they are operated on fairly quickly. It is, however, important to insure patients' safety and maximize their overall medical health before surgery. This may mean taking time to do cardiac and other diagnostic studies before surgery.

How is a hip fracture treated without surgery?

Patients who cannot have surgery include those who are too ill to undergo any form of anesthesia and people who were unable to walk before their injury and may have been confined to a bed or a wheelchair.

Certain types of fractures may be considered stable enough to be managed without surgery. Because there is some risk that these "stable" fractures may instead prove unstable and displace (change position), the doctor will need to follow with periodic x-rays of the area. If patients are confined to bed rest as part of the management for these fractures, they will need to be closely monitored for complications that can occur from prolonged immobilization. These include infections, bed sores, pneumonia, the formation of blood clots, and nutritional wasting.

How is a hip fracture treated with surgery?

Intracapsular Fracture

Hip Fracture | Boston Medical Center (7)

Repair of an intracapsular fracture with individual screws.

Hip Fracture | Boston Medical Center (8)

Repair of an intracapsular fracture with a single compression hip screw.

If the head of the femur ("ball") alone is broken, management will be aimed at fixing the cartilage on the ball that has been injured or displaced. Frequently with these injuries, the socket, or acetabulum, may also be broken. The surgeon will need to take this into consideration as well.

These injuries may be approached either from either the front or back of the hip. In some cases, both approaches are required in order to clearly see and fix the injured bone. For true intracapsular hip fractures, the surgeon may decide either to fix the fracture with individual screws (percutaneous pinning) or a single larger screw that slides within the barrel of a plate. This compression hip screw will allow the fracture to become more stable by having the broken area impact on itself. Occasionally, a secondary screw may be added for stability.

(Video) Is a Hip Fracture a Death Sentence?

If the intracapsular hip fracture is displaced in a younger patient, a surgical attempt will be made to reduce, or realign, the fracture through a larger incision. The fracture will be held together with either individual screws or with the larger compression hip screw.

In these cases, the blood supply to the ball, or head of the femur, may have been damaged at the time of injury (avascular necrosis). Even though the fracture is realigned and fixed into place, the cartilage and underlying supporting bone may not receive adequate blood. Over a period of time, this may cause the femoral head to flatten out. When this occurs, the joint surface becomes irregular. Ultimately, the hip joint may develop a painful arthritis, despite the surgical repair.

In the older patient, the chance that the head of the femur is damaged in this way is higher. It is generally felt that for these displaced fractures, patients will do better if some of the components of the hip are replaced. In some cases, this can mean a replacement of the ball, or head of the femur (hemiarthroplasty). In other cases, this can mean the replacement of both the ball and socket, or head of the femur and acetabulum (total hip replacement).

Intertrochanteric Fracture

Hip Fracture | Boston Medical Center (9)

Repair of an intertrochanteric fracture with an intramedullary nail. The nail is in the hollow cavity of the femur (thighbone) rather than on the side of it (as with a plate).

Most intertrochanteric fractures are managed with either a compression hip screw or an intramedullary nail.

The compression hip screw is fixed to the outer side of the bone with bone screws and hasa large secondary screw (lag screw) that is placed through the plate into the neck and head of the hip (see compression hip screw figure above). The design of the device helps increase the stability of the area and promote healing.

The intramedullary nail is placed directly into the marrow canal of the bone through an opening made at the top of the greater trochanter. A lag screw is then placed through the nail and up into the neck and head of the hip. There are no definitive studies to show that one device is superior to another. The decision as to which to use is based on the surgeon's preference and experience

Subtrochanteric Fracture

Hip Fracture | Boston Medical Center (10)

Repair of subtrochanteric fracture with a long intramedullary nail.

(Video) For Surgical First Assist: Hip Fracture Fixation with Trochanteric Nail

Hip Fracture | Boston Medical Center (11)

Interlocking screws at the end of the nail make it more secure.

At the subtrochanteric level, most fractures are managed with a long intramedullary nail together with a large lag screw or they are managed with screws that capture the neck and head of the femur or the area immediately underneath it, if it has remained intact.

In order to keep the bones from rotating around the nail or from shortening ("telescoping") on the nail, additional screws may be placed at the lower end of the nail in the area of the knee. These are called interlocking screws.

In certain cases, the surgeon may choose to use a plate rather than a nail. The plate will have screws that go into the bone from the lateral, or outer, side of the femur. A single large screw goes into the neck and the head of the femur and appears similar to the compression hip screw, but at a different angle. Secondary screws are then placed through the plate into the bone to hold the fracture in place

A locking plate may be used for more difficult to treat fractures.

What is recovery from a fractured hip like?

Pain Management

Pain after an injury or surgery is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover faster. Medications are often prescribed for short-term pain relief after surgery or an injury.

Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your treatment.


Patients may be encouraged to get out of bed the day after surgery with the assistance of a physical therapist. The amount of weight that is allowed to be placed on the injured leg will be determined by the surgeon and is generally a function of the type of fracture and treatment to fix it. The physical therapist will work with the patient to help regain strength and the ability to walk. This process may take up to three months.

Medical Care

Occasionally, a blood transfusion may be required after surgery, but longer term antibiotics are generally not necessary. Most patients will be placed on medicine to thin their blood to reduce the chances of developing blood clots for up to 6 weeks. These medicines may be in the form of pills or injections. Elastic compression stockings or inflatable compression boots may also be used.

(Video) Hip Fracture Types & Fixation - Everything You Need To Know - Dr. Nabil Ebraheim

Follow-Up Care

During the appointments that take place after surgery, the surgeon will want to check the wound, remove sutures, follow the healing process using X-rays, and prescribe additional physical therapy, if necessary. Following hip fracture surgery, most patients will regain much, if not all, of the mobility and independence they had before the injury.


What is life expectancy after hip fracture? ›

One-year mortality after hip fracture is 21% once the fracture is surgically addressed. If a hip fracture is not addressed with surgery, the one-year mortality is about 70%.

How long do you stay in hospital with a fractured hip? ›

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.

Is hip fracture surgery urgent? ›

Surgery to repair a hip fracture should be done within 24-48 hours. The longer you wait to get treatment, the weaker and frailer your body becomes. We live in an aging society; every day, 10,000 people in the U.S. turn 65.

What is the best treatment for a hip fracture? ›

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.

Is walking good for hip fracture? ›

Hip fractures in older adults can result in loss of mobility. This type of fracture also can lead to significant medical expenses. But a 2014 study published in the American Journal of Public Health offers hope. It suggests that four hours of walking each week can greatly reduce hip fracture risk later in life.

At what age do most hip fractures occur? ›

Most hip fractures happen to people older than age 60. The incidence of hip fractures increases with age, doubling for each decade after age 50. Caucasians and Asians are more likely to be affected than others. This is primarily because of a higher rate of osteoporosis.

How long does it take to walk normally after hip fracture? ›

It may take 6 months to 1 year for you to fully recover. Some people, especially older people, are never able to move as well as they used to. You will slowly return to most of your activities. You may be able to walk on your own in 4 to 6 weeks.

Can you fracture your hip and not need surgery? ›

A hip fracture almost always requires surgical repair or replacement, followed by physical therapy. Taking steps to maintain bone density and avoid falls can help prevent a hip fracture.

How painful is a fractured hip? ›

A broken hip is a serious injury that is very painful and can keep you from walking. People with broken hips may be at risk for other problems, such as pneumonia, blood clots, and muscle weakness. Some problems can be life threatening.

Can you go home with a hip fracture? ›

Most people who fracture a hip often have to undergo surgery to repair the fracture and ensure proper healing. A hospital stay for a fractured hip and surgery may only be one night. Some patients then go to a rehab center for physical therapy and recovery, but in many cases patients go directly home.

How long can you wait for surgery for a fracture? ›

There can be a delay of anything from 1-21 days between sustaining an injury undergoing any surgery that may be required. This information sheet will outline the advice for patients in the immediate aftermath of injury. What happens next?

Can you make a hip fracture worse? ›

Rest your leg as much as you can. Follow your doctor's instructions for using crutches or a walker. Too much activity or weight on the hip fracture can cause it to get worse.

Does a broken hip ever fully heal? ›

Left to itself, a fractured hip, like most broken bones, will mend itself. The healing process, however, requires immobilizing the joint through complete bed rest, which often takes three to four months. There is potential for other medical problems to develop, especially in the elderly.

Why is a hip fracture so serious? ›

Risk of Complications

During recovery, a hip stress fracture can immobilize a patient for a long amount of time, potentially leading to blood clots and decreased muscle mass. Post-surgical complications, like infections and pulmonary embolism, may also contribute to high death rates.

How do you sleep with a broken hip? ›

Stay away from low beds, very high beds, or soft mattresses. When you're lying on your side, support your operated leg with pillows between your legs. Back up until you feel the bed behind your knees. Move your operated leg slightly forward.

Is a hip fracture worse than a hip replacement? ›

Doctors have long known that hip-fracture surgery is a riskier procedure than elective hip replacements, which are done to treat severe arthritis.

How long does it take for a fractured hip to heal without surgery? ›

Depending on health and injury pattern this bone can take 3-4 months to heal without surgery. Physical therapy for hip and knee range of motion is started around 6 weeks once bone has healed enough to prevent displacement with motion.

Which condition is the biggest risk factor for hip fracture? ›

Osteoporosis is the leading cause of hip fracture. Age is also a major risk factor. Other possible risk factors for hip fracture may include, but are not limited to, the following: Excessive alcohol and caffeine consumption.

How long do you have to be on crutches after a hip fracture? ›

You will probably have to use crutches or a walker for at least 4 to 6 weeks. After that, you may need to use a cane to help you walk.

How long is physical therapy after a hip fracture? ›

So just how long will healing from hip fracture take? That too depends upon individual circumstances, and a specific answer can only come from your own health care team. However, most patients will spend at least 4 to 6 weeks in intensive rehabilitation therapy to get back on their feet after a hip fracture.

How soon can you drive after a broken hip? ›

Normally, driving should be avoided for the first 6 weeks and even travelling as a passenger is best avoided for the first three weeks (except for essential journeys), as getting in and out of a car can risk straining the hip and stretching the healing tissues. However, you should discuss this with your surgeon.

Can a hip fracture heal naturally? ›

Surgery is the most effective way to repair a hip fracture. However, if you can't have surgery for any reason, the bones may eventually heal themselves. Without surgery, the healing process can take 3 to 4 months, and strict bed rest is required to allow the bones to heal correctly.

Does a hip fracture require hospitalization? ›

You will likely be admitted to the hospital because of a hip fracture. You probably will not be able to put any weight on your leg or get out of bed.

Can you sit with a hip fracture? ›

Try not to sit for more than 45 minutes at a time without getting up and moving around. Do not sit in low chairs or soft sofas that put your knees higher than your hips. Choose chairs with arm rests to make it easier to stand up. Sit with your feet flat on the floor, and point your feet and legs outward a little.

How do you go to the bathroom with a broken hip? ›

Back up until you feel the toilet touch the back of your legs. Move your operated leg slightly forward. Bend both knees and lower yourself slowly on to the toilet seat using the counter top, sink, or toilet arm rests for support. To get up, reverse these steps.

Can you live alone after a hip fracture? ›

Individuals face a higher risk of dying following hip fractures. A new study published in the Journal of Bone and Mineral Research has found that living alone after experiencing a hip fracture may further elevate this risk.

Can a fracture be fixed without surgery? ›

If you break a bone, you might need surgery to repair it. Some people only need a splint, cast, brace or sling for their bone to heal. How long it takes to recover fully depends on which of your bones are fractured, where the fracture is and what caused it.

Can I walk on a fracture after 6 weeks? ›

You'll be given advice by your doctor about how much you should move your leg and when you can put weight on it. It takes around 6 to 8 weeks for a minor fracture to heal. You'll probably need to use crutches or a wheelchair during this time, until it's possible to put weight on the leg again.

How do you know when a fracture needs surgery? ›

The more severe the fracture is, the more likely it is that surgery will be recommended. For example, an open or comminuted fracture will require surgery to ensure that the bone fully grows back together and safely supports your weight.

Why is mortality so high after hip fracture? ›

Excess mortality after hip fracture may be linked to complications following the fracture, such as pulmonary embolism [5], infections [2, 6], and heart failure [2, 6]. Factors associated with the risk of falling and sustaining osteoporotic fractures may also be responsible for the excess mortality [1, 7].

Do fractures shorten life expectancy? ›

Fractures – Any Fractures – Shorten Life Expectancy

Fractures shorten life expectancy. A study of 30,000 women and men in Denmark, led by Jack Cush, M.D, found that a fracture, any fracture, increased that patient's 10-year mortality risk—but that the risk of death was highest in the first year after the fracture.

What is prognosis for 90 year old with broken hip? ›

The elderly broken hip life expectancy is good, but this type of accident does increase one's chances of dying when over the age of 65. While 4 out of 5 patients will survive a broken hip, one study showed that the overall mortality rate doubled over a 12-year period for those who had suffered from a hip fracture.

Can elderly survive hip fracture? ›

Experts estimate that some 18 to 33 percent of all older adults who have suffered hip fractures will die within a year, with even higher rates of death among people who have dementia or who live in a nursing home.

How serious is a broken hip in elderly? ›

A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age. Risk increases because bones tend to weaken with age (osteoporosis).

What can be done for a broken hip in the elderly? ›

Hip fractures in the elderly are usually treated with some type of surgery to fix the fractured bones. If possible, the surgery is normally done within twenty-four hours of admission to the hospital. Rarely is a fracture considered stable, meaning it will not displace if the patient is allowed to sit in a chair.

Which fractures take the longest to heal? ›

If you have an open fracture, your bone breaks through your skin. Open fractures are sometimes referred to as compound fractures. Open fractures usually take longer to heal and have an increased risk of infections and other complications.

Can you live with a broken hip without surgery? ›

A broken hip may also be allowed to heal without surgery. In some cases, if the hip is fractured, it may not need to be treated with surgery. For example, if the ends of the broken bone are impacted, or were pushed together due to extreme force from an accident of fall, the bone can heal naturally.

Is a broken hip worse than a hip replacement? ›

Patients undergoing surgery for a hip fracture are at substantially higher risk of mortality and medical complications compared with patients undergoing an elective total hip replacement (THR).

Why is a broken hip often fatal? ›

During recovery, a hip stress fracture can immobilize a patient for a long amount of time, potentially leading to blood clots and decreased muscle mass. Post-surgical complications, like infections and pulmonary embolism, may also contribute to high death rates.

How long is rehab for elderly with broken hip? ›

So just how long will healing from hip fracture take? That too depends upon individual circumstances, and a specific answer can only come from your own health care team. However, most patients will spend at least 4 to 6 weeks in intensive rehabilitation therapy to get back on their feet after a hip fracture.

What are three complications that may occur after a hip fracture? ›

Muscle atrophy (wasting of muscle tissue) Post-operative infection. Non-union or improper union of the bone. Mental deterioration following surgery in older patients.

How long does it take to recover from a 80 year old broken hip? ›

Encouragement and support from loved ones like yourself and the care team will be important in their recovery process. In most situations, it can take between nine months and one year to fully recover from this type of injury.

Should an 80 year old have hip replacement surgery? ›

But despite this, you're never “too old” to have your hip or knee replaced. “There is no age cutoff for joint replacement,” says Dr. Piuzzi. “Studies have found that people in their 80s and 90s benefit from hip or knee replacement as much as younger people.”


1. Hip Fractures | Mercy Regional Medical Center
2. Seven day allied health services for hip fracture, stroke and rehabilitation patients
(SA Health)
3. Kay Hoskey, MD, Talks About a Hidden Cause of Hip Fracture: Anne Arundel Medical Center
4. "STEP-HI" Hip Fracture Recovery Study
(UConn Health)
5. Facebook Live - Hip Fractures and Osteoporosis with Dr. Jamie Johnston & Don Scott
(Greater Baltimore Medical Center)
6. St. Joseph's Medical Center Accreditation in Hip Fracture Care - Lakeland News at Ten - May 8, 2013
(Lakeland PBS)
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