Hip Fracture Overview

A hip fracture is a break in the upper part of the femur (thigh bone). These injuries most often affect older adults whose bones have been weakened by osteoporosis. In younger individuals, hip fractures usually result from major trauma, such as a significant fall from height or a car or motorcycle accident.

Each year, over 300,000 people in the United States experience a hip fracture. The majority involve adults aged 65 and older who fall at home or in the community.

Hip fractures cause significant pain. Quick treatment and early mobilization (getting the patient moving again) are crucial to avoid complications like pressure sores, blood clots, pneumonia, and confusion in elderly patients. For these reasons, surgery is typically performed as soon as the patient is medically stable.

Anatomy of the Hip

The hip is a ball-and-socket joint. The “ball” is the rounded head of the femur (thigh bone). The “socket” is the acetabulum, a cup-shaped part of the pelvis that holds the femoral head. Fractures involving the acetabulum or pelvis are discussed in separate resources.

Types of Hip Fractures

Hip fractures generally occur in one of four areas of the upper femur:

- Femoral head: The ball portion that fits into the socket.

- Femoral neck: The narrow section just below the femoral head.

- Intertrochanteric region: The area below the femoral neck, between the greater and lesser trochanters.

- Subtrochanteric region: The upper portion of the femoral shaft, just below the trochanters.

The most common types are femoral neck and intertrochanteric fractures. Fractures of the femoral head are uncommon and typically result from high-energy trauma.

Causes

Most hip fractures in older adults result from low-energy falls on weakened, osteoporotic bone. In severe cases, the bone can break spontaneously during normal activities like walking or standing — sometimes described as “the break happens before the fall.” These spontaneous fractures often occur in the femoral neck.

Stress fractures from repetitive impact can also develop in the femoral neck, commonly seen in long-distance runners or military recruits during training. Subtrochanteric stress fractures are sometimes linked to long-term use of certain osteoporosis medications. Femoral head fractures almost always stem from high-impact injuries.

Symptoms

- Sudden, severe pain in the groin or upper thigh.

- Inability to stand, bear weight, or move the leg above the knee in most cases.

- The injured leg often appears shorter and rotated outward.

- Bruising on the side of the hip or thigh.

- Limited and painful movement.

- Some nondisplaced fractures may allow limited weight-bearing, though still painful.

- Stress fractures may cause gradually worsening pain rather than sudden onset.

Diagnosis

Patients are usually evaluated in the emergency room. Doctors take a medical history, perform a physical exam (checking sensation, movement, and blood flow), and order imaging.

- X-rays: The primary test; most hip fractures are visible on standard X-rays.

- CT scan: Used for more detail when X-rays are unclear or to help plan surgery.

- MRI: Occasionally needed to detect subtle or stress fractures not visible on X-rays.

Treatment

The vast majority of hip fractures require surgery to relieve pain and allow early movement. Surgery is ideally performed within 24–48 hours once the patient is medically optimized. Treatment depends on the fracture location, displacement, patient age, and overall health.

Femoral Neck Fractures

- Nondisplaced: Often treated with in-situ fixation using screws or a plate-and-screw construct to stabilize the fracture while preserving the natural hip.

- Displaced: These have a higher risk of disrupting blood supply to the femoral head, leading to possible avascular necrosis. Elderly patients are usually treated with partial hip replacement (hemiarthroplasty). In select active or younger patients, total hip replacement may be preferred. Younger patients may undergo open reduction and internal fixation to try to save the natural femoral head.

Intertrochanteric Fractures

These fractures occur in the region between the greater and lesser trochanters and are typically fixed surgically using either a sliding hip screw with a side plate or an intramedullary nail. Both methods provide strong stability and allow early weight-bearing.

Greater Trochanter Fractures

Isolated fractures here are usually stable and heal with protected weight-bearing using crutches or a walker. Additional imaging (such as CT) may be used to rule out extension into the intertrochanteric area.

Subtrochanteric Fractures

These are treated with an intramedullary nail inserted into the femoral shaft, often with additional screws for stability. A long side plate with compression screws is sometimes used as an alternative.

Recovery and Rehabilitation

Most patients begin physical therapy the day after surgery. Early movement helps prevent complications and improves outcomes. Physical and occupational therapists guide exercises, weight-bearing restrictions, and daily activities.

Patients may go home with home health therapy or to a short-term rehabilitation facility, depending on their mobility and support at home. Hip fractures in older adults can lead to lasting reductions in independence and function, making thorough rehabilitation essential.

Medical Care After Surgery

- Antibiotics are given briefly to prevent infection.

- Blood thinners are used to reduce clot risk.

- Pain is managed with a combination of medications (opioids used sparingly and for the shortest time possible, plus NSAIDs or acetaminophen).

- Medical specialists (internists, cardiologists, etc.) help manage other health conditions.