What is a hip fracture?
Hip fractures are cracks or breaks in the top of the thigh bone (femur) close to the hip joint.
It is sometimes referred to by doctors as a proximal femoral fracture.
Symptoms of a hip fracture include:
- not being able to lift, move or rotate (turn) your leg
- being unable to stand or put weight on your leg, although in some cases this is possible
- a shorter leg, or your leg turning outwards more on the injured side
If you think you have fractured your hip, you will need to get to hospital as soon as possible. This is likely to mean calling 999 for an ambulance. Try not to move while you are waiting for an ambulance and keep warm.
Treating a hip fracture
Hip fractures are almost always treated with surgery. About half of all cases require a partial or complete hip replacement (a surgical procedure to replace the hip joint with an artificial version). The rest need surgery to fix the fracture with plates and screws or rods.
Learn more in treating a hip fracture.
Recovering from surgery
After surgery, a rehabilitation programme that includes physiotherapy will be used to help recovery. This will involve different healthcare professionals, including occupational therapists and physiotherapists.
Rehabilitation is important for a successful recovery. There are dedicated rehabilitation units, called geriatric orthopaedic rehabilitation units (GORU), for older people with orthopaedic conditions.
Read more information about recovering from a hip fracture.
The right rehabilitation programme may help older people get back on their feet after surgery. Despite this, after a hip fracture some older people may:
- not regain the ability to move
- no longer be able to live independently in their own homes
Read more about complications of a hip fracture.
How common are hip fractures?
Hip fractures are more common in older people, mostly occurring in people who are around 80 years of age. They are four times more common in women.
Symptoms of a hip fracture
If you have a fractured hip:
- your hip will be painful
- you will not be able to lift, move or rotate (turn) your leg
Usually, you will be unable to stand or put weight on your leg, but occasionally this is possible. If the pain does not go away after a fall, do not ignore it.
If you have fractured your hip, you will need to get to hospital for treatment as soon as possible. Call for an ambulance and try to keep warm while you wait.
Other signs of a hip fracture can include:
- bruising and swelling around the hip area
- a shorter leg on the injured side
- your leg turning outwards more on the injured side
If you have fallen
You may feel shaken or shocked after a fall, but do not panic. Try to get someone’s attention by:
- calling out for help
- banging on the wall or the floor (if there is someone on the floor below you)
- using your aid call button (if you have one)
When someone arrives, ask them to call for an ambulance. If you are on you own, try to crawl to a telephone and dial for an ambulance.
Read more about what to do after a fall.
If you have fallen, you may also have other injuries, such as a knock to the head. If you do not get help immediately, you may also experience:
- hypothermia, when your body temperature drops below 35C (95F) as a result of being in a cold environment
- dehydration, when the normal water content of your body is reduced because you have not been able to eat or drink
Hip fracture causes
Most hip fractures in older people are the result of falls, often at home.
Around three out of 10 people 65 years of age or over will have at least one fall a year. Half of all people 80 or over will have at least one fall a year.
Falls are more common in older people because they are more likely to have other health problems that increase their risk of falling, such as:
- muscle weakness
- problems with balance
- low blood pressure (hypotension), which can cause dizziness and fainting
- reduced mobility (not being able to move as easily as a younger person)
- poor vision
A fall can lead to a hip fracture if bones are weak due to a condition called osteoporosis.
From about 35 years of age, you gradually lose bone density (how solid the bone is). This is a normal part of ageing, but for some people it can lead to osteoporosis.
Healthy bones are very dense, and the spaces inside the bones are small. In bone affected by osteoporosis, the spaces are larger. This makes the bones:
- less elastic (flexible)
- more likely to break
Learn more about osteoporosis.
Hip fractures in younger people
Hip fractures that occur in younger people are most often due to a serious accident, such as a fall from height or a car crash.
Diagnosing a hip fracture
As hip fractures often occur as a result of a fall, diagnosis usually takes place at a hospital. It may be necessary to call for an ambulance after someone has fallen or otherwise injured themselves.
Assessment in hospital
If you have been taken to hospital with a suspected hip fracture, doctors treating you will assess your overall condition. For example, they may:
- ask how you were injured and, if you have had a fall, ask if this is the first time you have fallen
- ask about any other medical conditions you have, such as a heart problem
- ask if you are taking any medication
- assess how much pain you are in
- assess your mental state, for example if you also hit your head you may be confused or unconscious
- take your temperature
- make sure you are not dehydrated (when the normal water content of your body is reduced)
Depending on your assessment, you may be given:
- pain medication
- a local anaesthetic injection near your hip
- intravenous fluid (fluid through a needle into a vein in your arm)
The healthcare professionals treating you will make sure you are warm and comfortable. When possible, you may be moved from the emergency department to a ward, such as an orthopaedic ward.
To confirm your hip has been fractured, imaging tests are used to create a picture of the bones in your hip. Some of these are explained below.
X-rays are a type of radiation (waves of energy) used to create an image of the inside of your body. X-rays are a very effective way of detecting problems with bones, such as fractures, and this is likely to be the first imaging test you have.
A magnetic resonance imaging (MRI) scan may be used if the diagnosis is uncertain. MRI scans use strong magnetic fields and radio waves to produce a detailed image of the inside of the body. MRI scans are very effective at confirming even subtle hip fractures.
A computerised tomography (CT) scan may be used if you are not able to have an MRI scan, or if there is not one available quickly.
Hip fracture treatment
Hip fractures are usually treated in hospital with surgery.
Types of surgery
Most people will need surgery to fix the fracture or replace all or part of the hip. There are a number of different operations, explained in more detail below.
The type of surgery you have will depend on:
- the type of fracture you have (where in the femur the fracture is)
- your age
- how physically mobile you were before the hip fracture
- your mental ability before the hip fracture, for example if you have dementia (an ongoing decline of the brain and its abilities)
- the condition of the bone and joint, for example if you have arthritis (a condition that causes pain and swelling of joints and bones)
Internal fixation means fixing the fracture (break in the bone) using devices to hold the bone in place while it heals, including:
This type of operation tends to be used for people over 65 years of age who have a fracture inside the socket of the hip joint (intracapsular) and for fractures outside of the socket of the hip joint (extracapsular).
If internal fixation is used for an intracapsular fracture, you will need follow up appointments over several months with X-rays to check you are healing.
Problems healing can sometimes lead to further surgery so an operation called hemiarthroplasty is preferred in older people.
Hemiarthroplasty means replacing the femoral head with a prosthesis (false part). The femoral head is the rounded top part of the femur (upper thigh bone) that sits in the hip socket.
Complete hip replacement
A complete hip replacement (arthroplasty) is an operation to replace both the natural socket in the hip and the femoral head with prostheses (false parts). This is a more major operation than hemiarthroplasty and is not necessary in most patients.
A complete hip replacement may be considered if you:
- already have a condition affecting your joints, such as arthritis
- are very active
- have a reasonable life expectancy
Read more about hip replacement.
Ideally, you will have surgery within 36 hours of your arrival at hospital, provided you are in a stable condition. You will first have a pre-operative assessment to check your overall health and make sure you are ready for surgery.
During your assessment you will be asked about any medications you are currently taking and any necessary tests and investigations will be carried out.
You will also have an anaesthetic assessment to decide what type of anaesthesia may be used. Different types include:
- spinal or epidural anaesthesia used to numb the nerves in the lower half of your body so you cannot feel anything in this area
- general anaesthetic makes you unconscious and prevents your brain from recognising any signals from your nerves, so you cannot feel anything
A hip fracture can be very painful. Throughout your diagnosis and treatment, you should be given medication to relieve your pain. This is initially usually given intravenously (through a needle into a vein in your arm), with a local anaesthetic injection near the hip.
You may be given antibiotics (medicines that treat infections caused by bacteria) before your operation. This has been found to reduce the risk of your wound becoming infected after surgery.
Surgery carries the risk of a blood clot forming in a vein. Because of this, steps will be taken to reduce your risk. This may include injections, such as heparin (an anticoagulant, which reduces the ability of the blood to clot).
You will continue to be monitored for venous thromboembolism throughout your stay in hospital. You may still need medication after you are discharged.
Depending on which type of surgery you are having (see above), the operation lasts around two hours.
Surgery will be performed by a team of healthcare professionals, including an orthopaedic surgeon (a surgeon who specialises in operating on conditions that involve the skeleton). If you have any questions about your operation, your surgeon or another member of the team will help you.
After the operation, you will begin your rehabilitation programme. This may take place in a different ward to the one where you had surgery.
Read more information about recovering from hip fracture surgery.
Alternative to surgery
The alternative to surgery is called conservative treatment. This involves a long period of bed rest and is not often used as it can:
- make people more unwell in the long term
- involve a longer stay in hospital
- slow down recovery
However, conservative treatment may be necessary if surgery is not possible, for example because someone is too fragile to cope with surgery.
Preventing a hip fracture
It may be possible to prevent hip fractures by taking steps to prevent falls and by treating osteoporosis (weak and fragile bones).
People over 65 years of age have an increased risk of falling. You can reduce your risk of falling by:
- using walking aids, such as a crutch
- assessing your home for hazards and making it safer
- using exercises to improve your balance
Read about preventing falls for more information and advice to reduce your risk of falling.
If you are diagnosed with osteoporosis, follow your treatment plan. If you can improve the health of your bones, you may have a lower risk of fractures.
Read information about how osteoporosis is treated.
Hip protectors are designed to reduce the impact of a fall and may be used to prevent hip fractures in older people.
These devices used to use padding or plastic shields, which attached to specially designed underwear. Padded material was used to absorb the shock of a fall, while plastic devices were used to divert the impact away from vulnerable areas of the hip. More modern hip protectors use a different type of material, which aims to include both of these benefits.
One of the biggest issues with hip protectors has been that people stopped wearing them, or found them uncomfortable. Modern hip protectors try to address this with a more comfortable fit and new features, such as ventilation to reduce sweating.
However, they are thought to be less effective for older people who remain active in their own communities.
Read about the causes of a hip fracture for more information on those at risk.
Recovery from a hip fracture
After a hip fracture, you will be given a rehabilitation programme of treatment to help you recover from your injury and any surgery you have had.
The aims of rehabilitation include:
- increasing your mobility (ability to move), particularly walking
- increasing your independence so you can wash and dress yourself and use the toilet without help
Your multidisciplinary team
Rehabilitation will usually involve a multidisciplinary team (a team of different healthcare professionals working together), such as:
- physiotherapists – healthcare professionals trained in using physical methods, such as massage and manipulation, to promote healing and wellbeing (Read more information about physiotherapy)
- occupational therapists – therapists who identify problem areas in your everyday life, such as dressing yourself or getting to local shops, and will help you work out practical solutions
- social workers – people involved in providing social services, who can advise on practical issues, such as benefits, housing and day care
- orthopaedic surgeon – a surgeon who specialises in operating on conditions that involve the skeleton, particularly the spine and surrounding joints
- geriatrician – a doctor who specialises in the healthcare of older people (if you are an older person)
- liaison nurse – a healthcare professional who may be involved in planning your discharge and keeping you and your family informed about the care you are receiving
Rehabilitation in hospital
If you are well enough, rehabilitation can be started as soon as 24 hours after surgery. While you are in hospital, your rehabilitation may take place in:
- an orthopaedic ward – a ward for people with conditions that involve the skeleton
- a rehabilitation ward – a ward for people undergoing rehabilitation programmes
- a geriatric orthopaedic rehabilitation unit (GORU) – a rehabilitation unit specifically for older people with orthopaedic conditions
How long you need to stay in hospital will depend on how fit you are. If you are otherwise healthy, you may be discharged from hospital after a hip replacement in three to five days.
An occupational therapist may assess your home to see if you will need any mobility aids fitted before you are discharged, such as hand rails. These will make it easier for you to regain your independence. You may also be provided with walking aids, such as a cane or crutch.
Your doctor and carer (if you have one) may also be told when you are being discharged so that plans can be made to support you. After you have been discharged, you may need to:
- return to hospital for a rehabilitation appointment
- see your doctor for a follow-up appointment
- have visits or telephone calls at home from healthcare professionals involved in your care
This will be discussed with you before you are discharged.
Your rehabilitation programme
Your individual rehabilitation programme may involve some of the following:
- weight-bearing exercises, where your feet and legs support your weight, such as brisk walking, keep-fit classes or a game of tennis
- non-weight-bearing exercises, where your feet and legs are not supporting your weight, such as swimming or cycling
- treadmill exercises, such as walking on a treadmill (a piece of exercise equipment with a moving conveyor belt that allows you to walk in one place)
- intensive physical training, such as meeting with an exercise instructor three or more times a week to exercise
- strength and balance training, such as weight lifting, to build and strengthen muscles and joints, improving your balance, stability and posture
There is currently not enough evidence to suggest one type of exercise programme is better than another. However, it is thought these types of programme will improve your mobility. Your individual programme will depend on:
- what is available in your local primary care trust (PCT)
- what exercises are most suited to you
Complications of a hip fracture
Some people may have a slow or incomplete recovery after a hip fracture. Complications can also arise from surgery.
Not everyone will completely recover after a hip fracture. This may depend on how healthy you were before your hip fracture. Some people may:
- not regain their previous level of mobility (ability to move)
- no longer be able to live at home
Around three people in every 10 who have suffered a hip fracture die within a year. Around one-third of these deaths are directly related to the fracture.
Complications from surgery
All types of surgery carry risks. Complications that can arise after a hip operation include:
- infection – the risk is reduced by using antibiotics at the time of the surgery and careful sterile techniques. Infection occurs in about 1-3% of cases and requires further treatment and often surgery
- blood clots – these can form in the deep veins of the leg (deep vein thrombosis) due to reduced movement, but can be prevented using special stockings, exercise and medication
- pressure ulcers (bedsores or pressure sores) –these can occur on an area of skin that is under constant pressure due to being in a chair or a bed for a long period of time
Your surgeon can discuss these and any other risks with you.