Derek L. Hill, D.O.

Fellowship-Trained Orthopedic Surgeon and Specialist

Understanding a Stress Fracture of the Hip

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girl playing volleyball gameA hip stress fracture involves the ball of the ball-and-socket hip joint. It is considered a serious injury to the bone due to overuse, and occurs for one of three reasons: high-energy injury, stress injuries or pathologic injury. Stress fractures occur when the hip bone experiences repetitive micro-trauma. The hip bone is broken due to significant force (i.e. falls, motor vehicular accidents and sporting events) on the bone. A pathologic fracture is due to a problem that abnormally weakens the bone. Some causes of abnormal bone weakness may include osteoporosis, tumors and even infections.

Bone constantly goes through a cycle of turnover where old bone is reabsorbed, and new bone created. If the bone cannot keep up during this process it can fracture. Proper bone alignment is maintained during a stress fracture, thus not visible at times on a regular x-ray. Displaced hip bones are concerning due to the delicate blood supply to the hip bone. Symptoms of a stress fracture usually show after a recent increase in activity like increased running mileage. An x-ray can be performed if a hip stress fracture is suspected, but some x-rays may appear normal. If this happens and injury is still suspected, a MRI or bone scan should be obtained.

Treatment available for hip stress fractures include modification of your activity levels, or discontinuation, to reduce pain and discomfort. Pain medication may not be used because they tend to hide important symptoms. Some hip stress fractures heal without surgery, but it may be needed if there’s concern that the fracture will displace.

Medical Disclaimer: Always consult your doctor for any concerns, medical opinion and/or treatment.

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Important Information to Know About Hip Fractures

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375x321_the_hipA hip fracture, regardless of the person’s age, is a serious thing and should be treated as such. In order to prevent, or get proper and timely care in the case of a hip fracture, there are a few things that are important to know.

What is a hip fracture, exactly?

A hip fracture refers to a break in the upper femur (thigh bone) in one of three places. It will break either in the head (the ball that fits into the pelvic socket), the neck (the horizontal piece of bone at the top of the femur), or between or below the greater and lesser trochanters (two bony humps that protrude along the outside edge of the femur).

What are the most common causes?

Falls and trauma. Folks who suffer from osteoporosis are especially apt to suffer a broken hip due to a fall, and trauma such as a car accident is also a common cause.

What are the 3 types of fractures?

Nondisplaced (the bone is broken but has not moved), minimally displaced (the bone has shifted slightly at the break), and displaced (part of the bone has become completely displaced).

What are the symptoms?

Symptoms can range from almost none in the case of someone who’s bedridden (rarely), to severe in the case of an active person and can be obvious from visible signs such as bruising and swelling to physical such as difficulty moving and extreme pain.

How can they be prevented?

Basically, there are two ways; keep bones healthy and prevent falls. Vitamin supplements and bone mineral density tests are important, as is improving home safety by installing such things as grab bars and non-slip rug liners.

Knowing the causes and signs are important, because a fracture can be made worse by walking or even simply standing on it. Once the fracture has been diagnosed, the treatment will depend on the severity and type of fracture, and recovery time will depend on the treatment and physical ability of the patient. Treatment can range from surgically resetting the bone with screws and pins, to a hip replacement. In the case of resetting the bone, the patient should try to be up and walking with the assistance of a walker, as soon as possible. A hip replacement may take up to 12 weeks to heal. Prevention is probably the most important thing here, because hip fractures can drastically affect quality of life, are a major source of disability, and may lead to life-threatening conditions such as blood clots in the legs.

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Hip Fracture Cause & Recovery

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PixmacPreview000087901002A hip fracture, which is often the result of osteoporosis, is a serious femoral fracture that occurs at the proximal end of the femur near the hip. This type of fracture is serious, especially for adults over 65, resulting in life-threatening complications. Your bones tend to weaken (osteoporosis) as you get older, which is why older people are more susceptible to hip fractures. Younger people can also suffer from hip fractures, but the cause is usually the result of car or cycling accidents.

There are signs and symptoms of a hip fracture to look for. These may include the inability to move after a fall, severe hip or groin pain, inability to bear weight on the leg of your injured hip, stiffness/bruising/swelling surrounding your hip area and shortness of the leg of your injured hip.

Not all hip fractures are readily visible on an x-ray, therefore an MRI is the next test option. In cases where the patient cannot afford an MRI or cannot fit in the scanner, a CT may be substituted. MRI sensitivity for fractures usually are greater than a CT. Once a fracture is identified it is determined if the patient will require orthopedic surgery. If an operation is necessary a full pre-operative general investigation including blood labs, ECG and a chest x-ray will be obtained. The surgery is a stress on the patient, especially if elderly due to the prolonged immobilization.

According to Mayo Clinic Staff (2012), “A hip fracture almost always requires surgical repair or replacement, followed by months of physical therapy. Taking steps to maintain bone density and prevent falls can help prevent hip fracture.” Occupational therapy and/or physical therapy is a very important process in rehabilitation, as it has been known to increase daily function for a healthy recovery. About 2% of hip surgery recipients experience a deep or superficial wound infection. If the infection is superficial it could lead to a deep infection including the healing bone. It could also contaminate the implants, which requires implant removal once the infection has been treated and clears up.

Medical Disclaimer: Always talk to a medical consultant before starting a new exercise routine, returning to exercise after injury or surgery, or if you have any health care-related questions.

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Different Types of Hip Fractures

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mature female doctor with group colleaguesA hip fracture occurs when the femur (thigh bone) breaks. It is usually the result of a fall, though it can also be caused by direct blows to the hips during traumatic events like road traffic accidents. Hip fractures can also be caused by medical conditions like cancer and osteoporosis.

Regardless of the cause, symptoms of fractured hips include pain over the upper thigh or groin region which increases when the person tries to move the leg.

According to the National Center for Biotechnology Information, the classification of hip fractures depends on whether the thigh bone breaks at the femoral neck, the intertrochanteric region, or at the subtrochanteric level.

Femoral Neck Fractures

Fractures of the femoral neck occur in a narrow section of the thigh bone, which lies just below the head of the femur. These fractures are also referred to as intracapsular fractures, since most of them occur inside the capsule that surrounds the joint. Femoral neck fractures can damage the arteries that supply blood to the head of the femur. This can lead to a condition known as avascular necrosis, in which the round head of the femur flattens and develops irregular joint surfaces which cause arthritis.

Fractures of the femoral neck are usually treated surgically, with the surgeon attempting to fix the broken bone with screws. In older patients with displaced fractures, the orthopedic surgeon may also do a total hip replacement and replace the head of the femur and the acetabulum (hip socket) since they have a higher risk of developing arthritis due to the disruption of blood supply to the femoral head.

Intertrochanteric Fractures

The American Academy of Orthopedic Surgeons describes intertrochanteric fractures as those which occur below the femoral neck and the lesser trochanter. The lesser trochanter is a bony prominence on the femur that serves as an attachment point for hip muscles.

Intertrochanteric fractures of the hip are treated surgically with a compression hip screw, which is fixed on the outer side of the femur. These fractures can also be fixed with an intramedullary nail that is inserted into the thigh bone.

Subtrochanteric Fractures

Subtrochanteric fractures occur below the lesser trochanter. According to John Hopkins Medicine, they are less common than fractures of the femoral neck and those of the intertrochanteric region.

Subtrochanteric fractures are treated with an intramedullary nail, which is inserted into the femur. These fractures can also be treated with locking plates placed on the outside of the femur and secured with screws.

After surgery to treat hip fractures, most patients stay in the hospital for a few days before being discharged. They are usually sent home with pain killers and medications to thin their blood and prevent clots. Rehabilitation is begun during their hospital stay and it is determined by the type of fracture they sustained and how it was treated. Patients continue with their exercises once they are discharged, in order to regain their muscle strength and mobility.

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