Hip Fracture Basics: Types and Causes of Broken Hips

Hip fractures are serious injuries that often require surgery to repair. Every year in the United States alone over 300,000 people suffer broken hips and require hospitalization. Of that number, over half of those people suffering a hip fracture are over the age of 80.

Bone density, age, and other medical conditions can all contribute to the likelihood of a broken hip, but generally a fracture occurs because of some sort of trauma to the area, like a fall. Most hip fractures in the elderly are caused by falls, while in younger patients – car accidents and other high impact injuries are the most likely causes.

Elderly women and other patients with osteoporosis are at a greater risk of suffering a broken hip in the event of a fall. Because osteoporosis weakens the skeletal system by causing loss of bone mass – bones and joints are at a greater risk of fracturing in the event of trauma.

Hip fractures are actually the breaking of the femur (the bone that extends from the pelvis to the knee) inside or near the hip joint. Hip fractures are generally placed into 2 main classifications – a Femoral Neck Fracture or an Intertrochanteric Fracture. Both of these types of fractures are very serious and in most cases will necessitate surgery to repair the fractures.

Femoral Neck Fracture

The femoral neck is just below the head (top) of the femur. A femoral neck fracture generally occurs within 1 to 2 inches from the end of the femur.

Intertrochanteric Fracture

This fracture occurs within 3 to 4 inches of the head of the femur and usually requires the use of a metal plate and screw to hold the bone in place while it heals – allowing the head of the femur to continue moving normally in the hip socket.

Though hip fractures are generally caused by a serious trauma – a fall or a high impact injury – other factors can contribute to the risk of sustaining a broken hip.

Age

Statistics show that age is a large factor. The majority of hip related injuries and fractures occur in people over 80. There are two main reasons why this may be true: bone density loss and the presence of other medical conditions affecting balance and mobility. But also effecting elderly patients are general aging issues like loss of vision and a decreasing or weakening sense of balance.

Medical Conditions

Osteoporosis puts patients at an even higher risk for breaking a hip simply because it reduces bone density. There are a number of other medical conditions that will also lead up to and increase chances of developing osteoporosis which in turn can lead to increased risks for hip fractures.

The development of other diseases and conditions like Parkinson's disease which effect a person's mobility and balance can contribute to an increased risk of falling and breaking a hip as well. Diabetes, arthritis, and similar diseases can also effect a person's activity levels which in turn increases risk.

Physical Inactivity

Because physical inactivity can lead to the weakening of bones, tendons, and muscles – it can also contribute to a higher risk of fracturing critical bones and joints. Physical inactivity can in turn lead to other conditions such as obesity and weight gain which can put a larger strain on a weakening bone structure. Maintaining a regular physical activity schedule will often reduce a patient's risk of hip fracture.

Mortality Rates and Common Problems Associated with Hip Fractures

Hip fractures are serious injuries that require immediate medical attention because there are a number of problems and conditions that can arise because of the broken bone. Studies have shown that mortality rates following a hip fracture can be rather high for a number of reasons which include the development of other serious medical conditions (blood clots and infections) as well as the age of the patient at the time of the injury (since the majority of fractures occurs among seniors).

A study published in the British Medical Journal places mortality rates within one year of suffering a fractured hip at 20%. And this number only increases with the age of the patient – as many as 33% of patients over the age of 80 die within a year of breaking a hip. The 30 day mark following surgery for a fractured hip is high in this population also – coming in at about 10%.

A number of factors contribute to these high numbers. Post-operative complications like infections (i.e. pneumonia or bronchitis) are dangerous factors. The general health of the patients involved in the study also contributes to the high mortality rates. Because as we talked about, a number of other conditions can increase a patients risk of breaking a hip. These same conditions (obesity, diabetes, osteoporosis, Parkinson's, and others) can also make recovery more difficult.

Mobility factors increase risk as well. Because a broken hip makes it even more difficult for patients to get proper exercise, the overall deterioration of the body due to inactivity can bring about other health problems or exasperate existing conditions like heart disease. For patients that are bedridden following surgery, pressure sores and infections become an increased risk.

Overall, the general health of a patient prior to the sustained injury and following surgery is going to play highly in determining the likelihood of the patient's complete recovery. This is why younger patients tend to recover more completely and quickly as they are less likely to have preexisting medical conditions that are going to be worsened by the injury.

Mortality rates and other complications decrease significantly in patients that work hard at maintaining an active and healthy lifestyle regardless of age. Often for these folks – a broken hip is a temporary setback, though it is still a serious injury. Recovery though will often be a lot simpler if the patient has maintained general good health prior to fracturing their hip.

How Hip Fractures are Treated

In most cases, a hip fracture is going to require surgery. In cases where surgery is not possible because of an illness or other factor – traction may be used. In those cases without surgery – the main treatment for a broken hip relies mainly on pain reduction.

Both types of hip fractures – the femoral neck fracture and the intertrochanteric fracture - require surgery. The exact procedure is slightly different for each type.

Intertrochanteric Fracture Surgery

When the break is lower on the femur as in an intertrochanteric fracture (occurring 3 to 4 inches from the head of the femur) a different procedure is generally used. Doctors will attach a metal plate to the side of the femur and insert a metal hip compression screw into the femur. This compression screw and plate allows the bone fragments to compress together and mend themselves.

Femoral Neck Fracture Surgery

With a femoral neck fracture, surgery will generally involve one of three types of procedures: metal screws, replacing part of the femur, or total hip replacement.

Using metal screws, the surgeon will align the bones and fix them in place with three long metal screws which will remain in place and not be removed. These screws serve to allow the bones to mend back together as well as strengthen that section of the femur.

If the doctors are unable to align the bones in a way that will allow them to heal properly, they will usually attempt a procedure known as a hemiarthroplasty. This involves removing and replacing the damaged head and neck of the femur with a metal prosthesis.

Total hip replacement is the most invasive of the three options. If for some reason, the socket joint in the hip is damaged – total hip replacement might be the best option. In this procedure, the surgeons will not only replace the top portion of the femur, but also the joint section of the pelvic bone. One of the benefits of total hip replacement is that it allows patients to become mobile again sooner after the surgery than other options. This can help to prevent other complications associated with major surgery from developing.

Hospital stays after surgery for a hip fracture can vary in length – although the average stay in the hospital generally lasts a week. The majority of patients will require physical therapy for a long period following the surgery to recover completely. Older and less mobile patients may even have to look to a long term care facility if they don't have available help or care at home.

Help With Recovery and Prevention of Hip Fractures

Exercise and physical activity is a key in helping with both recovery from a hip fracture and prevention of those fractures. Because mobility is limited following surgery for hip fractures, the use of a walker is often a good idea for elderly patients as it will help them get the exercise to speed up healing and also help to prevent another fall from aggravating the injury further.

Everyday tasks will probably become a little more difficult for a patient recovering from hip fracture surgery. Things like bending over to tie shoes or getting dressed in the morning will require a little bit of extra effort. Lifting the affected leg into bed or onto the couch will also become more difficult at times during the recovery. There are quite a few products like extended shoe horns and leg lifters which can ease the pain and difficulty of recovery.

Often times, simple tasks that are taken for granted become more complicated. Bathing for example is an everyday thing that becomes tough following hip surgery. A sponge on an extended handle or a bath bench become tools which can really help.

To make recovery easier, the purchase of a "hip kit" is a small investment for quite a bit of help. Common items that you'll find in a hip kit include:

• Long Handled Sponges
• Long Handled Shoe Horn
• A Dressing Stick
• Extendable Reachers or Grabbers
• Leg Lifters

Mobility and physical therapy are both important factors in helping to speed up recovery. Full use of the hip will take some time, but in patients that were healthy prior to the surgery, a full recovery is possible and likely.

Exercise is a major factor in recovery as well as the prevention of other complications arising because of the surgery. Any help that a patient can enlist – either from family or qualified medical practitioners is going to aid them in recovery.

Prevention Tips

Learning how to prevent falls is another factor that is going to seriously limit the likelihood of breaking a hip.

• Building railings or ramps to help with stairs around the home is a good idea.
• Installing rails next to the toilet and in the bathtub or shower is another preventative measure. They're also great ideas to help somebody who is trying to recover from hip surgery since their mobility will be more limited for a time.
• Rearranging furniture to allow for clear paths.
• Check rugs and carpets for slippage or places somebody could trip.
• Consider the use of a hip protector – a low profile pad that you wear beneath your clothing and over your hip to help absorb any impact from a fall.
• Keep cords stowed safely away.
• Place used items in easy to reach places – avoid step stools and ladders where balance might be lost.
• Make sure areas of the home and yard are well lit. Being able to see a hazard is half the battle.
• Wear practical shoes that are non-slip.

Maintaining a healthy lifestyle can also decrease your risk of breaking a hip. Not only exercise, but proper nutrition is important.

• Weight Bearing Exercise – Helps to fight bone density loss and works to maintain the strength of tendons and muscles that support the joints. Not only that, but regularly walking or exercising will help to maintain your sense of balance and agility – making the likelihood of a fall less likely.
• Smoking – Believe it or not, smoking actually works to reduce your bone density. So not only can it cause cancer – but it can weaken your bones.
• Calcium and Vitamin D – Proper nutrition and watching levels of calcium in your diet (through foods or supplements) will work to maintain your bone density so that in the event of a fall, you are less likely to fracture your hip. Vitamin D is also a key component of this process as it helps your body absorb and process calcium.

Other Hip Fracture Resources

There are a ton of available resources on the web these days that can help you in the prevention of or recovery from a hip fracture. The following is a listing and review of some great web sites and articles if you would like more information on hip fracture prevention, treatment, and recovery.

The Mayo Clinic

The Mayo Clinic is a highly respected non-profit organization and clinic that maintains clinics in Minnesota, Arizona, and Florida. They also have a very informative web site that is a great resource for countless medical conditions. The section of the web site on hip fractures is very in depth and organized in a way that you can find information very easily on prevention of hip fractures or help with recovery from hip surgery.

Care.com

Care.com is an interesting web site in that it deals with the care of patients following surgeries like total hip replacement. On this web site you'll find questions and tips related to helping patients or parents who are going through a difficult hip surgery recovery.

Advice on how to deal with the medical condition is provided, as well as advice on how to help the patient mentally get through the recovery is discussed.

This web site also provides access to a network of caregivers and service providers in your area if you need additional help with recovering from hip surgery. You can find providers for any level of help that might be needed, from full time care to part time help with housework and chores. The great thing about this service is that you can post your needs and interview potential caregivers as well as look at a background check.

EveryDayHealth.com

Maintaining an active and healthy lifestyle are the best preventative measures that you can take towards avoiding a hip fracture. Working as an online community and resource, EveryDayHealth.com is a great resource and web site to use to maintain that active and healthy lifestyle.

Nutrition information and tools like their ‘meal planner' and ‘weight tracker' are great ways to make sure you are doing everything you can to stay healthy. Participating in the community forums is also a great way to meet other people facing the same issues or working towards the same goals.

Hip fractures are a common injury, especially among the elderly – so reaching out to a community like EveryDayHealth will give you the opportunity to find understanding support of what it is you might be going through following hip surgery.

Finding the proper support, medical care, and tools to aid in the recovery from hip fracture surgery is a key component to reducing the difficulty and likelihood of complications from a broken hip. Whether you have experienced a hip fracture or are just interested in the prevention of a future injury – there's a myriad of online resources available to help you in that quest.