Symptoms of hip fracture

The symptoms of a hip fracture can be severe, especially in the elderly, where the complications can be fatal.

As a rule, hip fractures occur at the age of over 65 years, from the age of 80 the risk increases rapidly.

Older people are particularly at risk because the bone becomes more brittle with age. This loss of stability is called osteoporosis. Taking certain medications, vision and balance disorders increase the likelihood of tripping and falling, which is one of the most common causes of hip fracture.

Women are affected more than twice as often as men.
Femoral fractures can be very serious due to complications such as necrosis of the femoral head (death of bone cells).

Risk factors

Heritability can also increase the probability; Children of hip fracture patients are more susceptible to suffer such a fracture themselves.
Lean people are more susceptible because they usually have a lower concentration of calcium in the bone (osteopenia or osteoporosis).

Smoking and excessive alcohol consumption are also among the risk factors.
Patients with mental, neurological and visual impairments are more likely to fall and suffer a femoral fracture.
Thigh lesions represent a high social and financial burden for society with regard to the care of mostly elderly patients.
Femoral fractures are very dangerous, without surgical intervention, the mortality rate can be more than 30%.
The fracture can occur on the right as well as on the left side of the hip; a bilateral fracture is extremely rare.
A hip fracture, like a dislocation, is very rare and is usually the result of a traffic accident.

What is the cause of a hip fracture?

The femur is particularly vulnerable to injury due to its shape and position in the hip joint and by carrying body weight.
Osteoporosis (decreased calcium density in the bone) makes the femur more susceptible to injury, especially in the elderly.
A slight blow can be enough to severely damage the bone and surrounding structures.
The most common causes include simply falling down when walking, due to inappropriate footwear, slippery or uneven surfaces or sudden yielding of the knee joint.
In some cases, the fall may be the result of a spontaneous femoral neck fracture.

As women age, their bone density decreases by 30-50%. Bone loss increases after menopause because fewer estrogens are produced and estrogens maintain bone density and bone strength.

The pathological fracture can occur as a result of a bone-weakening disease, such as a bone tumor or metastases.
In this case, the hernia is handled differently, the doctor can advise surgical intervention only if the patient is operational.

Classification of femoral fractures

The femur consists in the proximal part (ie at the level of the hip) of a spherical head and a cylindrical neck.
The femoral neck connects the femoral head, also known as the femoral head, with the rolling mound and femoral shaft.
The following fractions are possible:

• Intracapsular, that is, inside the joint capsule, if they affect the femoral neck; this is the most dangerous form because the blood vessels supplying the femoral head can be damaged and thus cause bone necrosis.
• extracapsular, if the fracture is localized on the rolling hill; in this case, the risks of bone necrosis or lack of bone healing are very low because this area is well supplied with blood.

The extracapsular fractures are divided into:

Pertrochanteric fractures
In pertrochanteric fractures, the femur breaks below the femoral neck and because the bone fragments are optimally supplied with blood, this type of fracture causes fewer problems.

The fracture site lies between the femoral neck and a deeper smaller bone protrusion, the so-called small rolling hill (trochanter minor). The small rolling hill is the starting point for some of the most important hip muscles, such as the lumbar iliac muscle.
As a rule, pertrochanteric fractures lie between the small and the large rolling hill. The large rolling hill (trochanter major) is the bone protrusion that can be felt on the far right of the hip under the skin. This is where various important muscles come in.

Subtrochanteric fractures
A subtrochanteric femoral fracture lies below the small rolling hill.
The bone can break into several pieces.
In more complicated cases, the fracture can extend to different areas of the femur.

What are the symptoms of a femoral fracture?

The main symptoms of femoral injuries are: pain and the impossibility of standing and straining the broken leg.
A few days after the trauma, swelling and bruising become noticeable.
The injured person cannot get up from the ground without help.

The pain occurs with passive hip movements.
Pain also occurs when tapping the heel.
With a tuning fork held over the hip, the symptoms can be reproduced.
The patient can not walk normally and limps.
The movements are limited and cause pain in the hip, especially the internal rotation.
Deep palpation in the groin is painful.
The injured leg may be shortened and twisted.

Complications

A hip fracture is a serious injury that can severely limit the independence of the person in the future, and in some cases even shorten life. Many adults with hip fractures are still in a nursing home a year after the accident, even though they were completely independent before.

If the hip is immobilized for a long time, the following complications may occur:

• Deep vein thrombosis or pulmonary embolism
• Wound bed ulcer (bedsores)
• Urinary tract infection
• Pneumonia

In addition, patients with hip fractures are significantly more at risk of relapse.
People with an artificial hip joint can fall and suffer another fracture. In this case, the prosthesis may detach from the bone and a new intervention is necessary to replace the old prosthesis with a new one.

How is a femoral fracture diagnosed?

The doctor examines the medical history and asks the patient about the accident to understand whether a femoral fracture could be present.
If the symptoms match, the clinical examination will show a shortened, outwardly rotated leg due to the pulling force exerted by muscles and gravity.
As a test, passive internal rotation with flexion is particularly suitable for these fractures; in case of severe pain, the test is to be evaluated as positive.

An X-ray examination is the most appropriate diagnostic procedure for a femoral fracture. The images indicate a possible interruption of bone continuity. Fine fractures may not be visible on the X-ray on the day of the injury, but as the fracture gap widens over time, it is clearly visible after 2-3 days.

In the case of microfractures, magnetic resonance or bone scintigraphy may be necessary to confirm the diagnosis.

How is a femoral fracture treated?

The orthopaedist must first weigh the case all around; for example, a young patient will receive different treatment than an older patient.
In young people, osteosynthesis occurs to hold the bone fragments together; intramedullary gamma nails, screws and plates are used. After the operation, the leg is cast for about a month.

As a rule, the surgical procedure is also performed in the event of a displaced fracture in order to hold the bone fragments together and make a faster return to everyday activities possible.

In elderly patients, the surgical form of treatment consists in a prosthesis of the hip joint; The joint between the femur and the acetabulum is replaced by a metal prosthesis.
In the case of a hip fracture within the joint capsule, this procedure is always preferable, because in this way healing and immobilization times can be reduced and complications caused by prolonged bedridden can be avoided; these include pulmonary embolism, deep vein thrombosis, bedsores on the back and heel, etc.
In case of injury to the rolling hill, conservative treatment is usually chosen, which provides for immobilization of about 4-5 weeks in the plaster cast; then the walking process begins with the help of forearm crutches.

Possible effects:

• femoral head necrosis, if the surrounding arteries are damaged; occurs with medial, i.e. internal injuries, even after surgical intervention;
• pseudoarthrosis on the femoral neck; occurs with medial ruptures due to insufficient blood circulation;
• A faulty consolidation can be seen in lateral, external fractures; it can occur in valgus or varus position; the latter leads to premature osteoarthritis.
• Joint fractures cause premature osteoarthritis.

What rehabilitation helps with a femoral fracture?

In a surgical procedure, it is necessary to start walking as soon as possible, if the pain allows it.
If, after osteosynthesis, the plaster is removed, the load must be gradual; it is important to start as soon as possible a program to strengthen and promote the elasticity of the ankle, knee and hip joints.
Rehabilitation generally takes about a month, but the times vary greatly from person to person; some patients take longer to fully bend and stretch their hips again without pain.

How long are the recovery times? The prognosis for recovery

After surgery, the healing times depend on the patient’s state of health; a young person needs about two months, while an older woman with osteoporosis takes up to 6 months to return to pre-fracture levels.
In some cases, a certain stiffness (restriction of movement) or hip pain remains.

Read more:

• Surgical treatment of a hip fracture
• Femoral fracture
• Surgical treatment of a femoral shaft fracture