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Every year, 1.5 million people around the world suffer fractured hips. A hip fracture is painful and incapacitating, and it can even lead to death. But it is possible to recover.

Hip fractures are a dreaded complication of osteoporosis. The Centers for Disease Control tell us that there are about 340,000 hip fractures every year in the United States. Nine out of ten hip fractures occur in people over the age of 65. Three out of four hip fractures occur in women. But nearly 10,000 people a year under the age of 40 suffer hip fractures even without osteoporosis, usually after strenuous exercise that is new, strenuous, and repetitive. When football, rugby, and soccer players subject the hip to repeated stress, microfractures can build up until something causes a break.

Symptoms of hip fracture

Hip fractures present a variety of symptoms. A 30-year-old player in the women's baseball league might come into the ER with a broken hip after sliding into base. An 85-year-old man might suffer sudden hip pain and inability to walk after bending over to put food in the cat's bowl. 

The classic cardinal symptom of hip fracture is extreme pain.Hip fractures hurt a lot. The pain may extend down the thigh to the knee, even if the thighbone and knee are not fractures. The leg may rotate outward and appear shorter. The reason a hip fracture makes the leg look shorter is that the muscles that extend it depend on an intact femur to stretch out. In severe breaks in the bone, there may be interference with circulation in the leg. Loss of blood flow can create a medical emergency. If you can't stand up at all, you need to get to a doctor right away.

Stress fractures of the hip present symptoms that are less severe. The patient may feel fine while seated perfectly still, but walking is painful. Pain from a hip fracture may radiate down to the knee and over to the groin. Intermittent pain may become constant pain if the patient continues using the hip as if nothing at happened. However, this pain is relieved by rest.

Sometimes emergency room doctors in a hurry will misdiagnose a hip fracture as sciatica. The difference between the two conditions is obvious is the doctor orders X-ray and/or MRI, but from the patient's point of view, there is a simple way to distinguish them. If pain extends from the hip to the knee down the front of the leg, then the problem is more likely to be a fracture. If pain extends from the hip down the back or sides of the leg, then the problem is more likely to be sciatica. Don't let an ER doctor dismiss you before the radiologist's interpretation of your X-rays has been done.

How do you recover from a fractured hip?

Acute injury to the hip requires medical evaluation. Some hip fractures can only be repaired by surgery. The need for surgery is a medical decision. When surgery is required, sooner is usually better than later. The needed surgery may not be a hip replacement. Sometimes a fracture is small enough that it can be addressed with an internal fixation device, which is surgically implanted and then surgically removed 12 to 18 months later. And sometimes the fracture is painful but does not require surgery. Rest and rehab sometimes are enough. But in just about every case:

  • It's necessary to keep weight off the hip joint. This means cessation of sports activities and exercise while the hip is healing. Some patients may get around on crutches. If lower body mass is too high or upper body strength is too low, then it may be necessary to use a scooter or a wheelchair.
  • Pain medication is necessary. Aspirin or Tylenol aren't usually enough. The doctor will prescribe muscle relaxers that help the leg muscles extend over the femur and probably some kind of opiate to get through the pain. Acupuncture, transcutaneous electroneural stimulation (TENS), and heating pads may also help. Controlling pain doesn't just help you feel better. It also helps your bones heal faster. You should not return to normal activity while you are still using pain medications.
  • It's better not to be brave about bearing your pain. You should not complain about pain so much that you drive off people who are helping you cope, but it also a mistake to keep on with your daily routine as if nothing happened. Continual stress on the joint may make recovery impossible. Stop your exercise program and your daily work schedule long enough to allow your joint to heal.

What is it about a broken hip that can cause permanent disability or even death?

We all hear stories about people who break their hips, become permanently disabled, and even die. The fracture that leads to disability or death may not be as severe as the fracture that turns out only to be an interruption in a young athlete's career. There are other factors that make hip fractures deadly serious:

  • A person who suffers dementia and has a hip fracture is at elevated risk for disability and death. Special precautions need to be taken to fall-proof the home.
  • Anyone who takes an antidepressant may have an especially tough time recovering from a hip fracture. Some, although not all, antidepressant drugs interfere with the process of building new bone.
  • And something as simple as buying new shoes makes a difference when patients begin walking again. Old, worn shoes may interfere with balance, and loss of balance can lead to falls. As a general rule, it's a good idea to throw out shoes that have been worn every day for more than six months.

  • Blankenbaker DG, De Smet AA. Hip injuries in athletes. Radiol Clin North Am. 2010 Nov. 48(6):1155-78.
  • Brännström J, Lövheim H, Gustafson Y, Nordström P. Association Between Antidepressant Drug Use and Hip Fracture in Older People Before and After Treatment Initiation. JAMA Psychiatry. 2019 Jan 2.
  • Sieber FE, Mears S, Lee H, Gottschalk A. Postoperative opioid consumption and its relationship to cognitive function in older adults with hip fracture. J Am Geriatr Soc. 2011 Dec. 59(12):2256-62..
  • Photo courtesy of SteadyHealth.com

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