Hip Fractures: Everything You Need to Know

Hip fractures have a high mortality rate, as most patients who suffer this injury are elderly and often in poor health already.
Hip Fractures: Everything You Need to Know

Last update: 10 September, 2021

Hip fractures (HF) are serious and sometimes life-threatening injuries. They’re the most severe complication of osteoporosis and, unfortunately, a very common health problem in the elderly. In countries such as Spain, for example, there are around 60,000 cases a year, i.e. 1 case for every 1000 people.

Most of those who suffer hip fractures are over 80 years of age, which complicates the clinical approach and possible recovery. If you want to know more about hip fractures and their prognosis, read on.

What is a hip fracture?

A hip fracture (HF) is defined as an injury and bone fracture that occurs at the level of the top end of the femur, as described by the Spanish National Research Council. Depending on its location, it can affect the femoral head, the femoral neck, the trochanters or other segments.

Fractures of the femoral neck are intracapsular, that is, they’re found inside a joint capsule; in this case, at the insertion point between the femur and the pelvis. Trochanteric injuries and injuries in other segments are classified as extracapsular, since they don’t affect the joint itself, but rather along the bone.

According to documents on the professional portal Medigraphic, the different types of hip fractures are distinguished on the basis of many parameters. Depending on how much the damaged portion is displaced, the following categories are defined:

  • Grade I: incomplete fracture or abduction.
  • Grade II: complete fracture, but with no displacement of the structures involved.
  • Type III: complete fracture with partial displacement. The separation is less than 50%.
  • Type IV: complete fracture with total displacement. The previously united bony structures are no longer touching.
Osteoporosis in a bone.
Osteoporosis is a risk factor for hip fracture, which is why older women are more at risk.

What causes hip fractures?

As the Mayo Clinic points out, a severe impact – such as in a car crash or a fall from a great height – can cause a hip fracture in anyone, regardless of gender or age.

However, as already mentioned, most patients are 80 or older, and the incidence is higher in women. This is due to the higher prevalence of osteoporosis in this age group, which makes bones much more vulnerable to mechanical stresses and shocks.

Bones are not completely sealed tissues, as they’re created and destroyed according to individual growth and physiological demands. This process is known as remodeling. After the age of 30, the rate of destruction of bone tissue exceeds the rate of production, causing bones to become fragile, porous and weak.

Thus, the same impact in an elderly patient with osteoporosis is much more likely to break a hip than in a young person. Most clinical events occur when the individual falls from a standing position, thus producing a femoral rupture of greater or lesser severity.

Risk factors

As you’ll have noticed, being elderly is the greatest risk factor when it comes to suffering a hip fracture. Even so, other factors can also increase the chances of this type of serious injury.

These include the following:

  • Sex: Women lose bone density at a faster rate than men; hence 80% of patients who suffer hip fractures are female. This is due, in part, to the drop in the production of sex hormones–such as estrogen–during menopause.
  • Osteoporosis: As already stated, suffering from osteoporosis increases the chances of suffering a hip fracture after a fall.
  • Nutritional problems: Deficiencies of calcium and certain vitamins can result in a lack of bone density during growth and development.
  • Alcohol and tobacco use: These addictive toxins and other drugs disrupt the rate of bone production and wear.

If you’re not elderly, reckless driving, drug use, and a lack of physical exercise are some of the events that can lead to an accident involving hip fractures. However, it’s unlikely a young person with a healthy lifestyle would suffer an injury like this.

Symptoms of a hip fracture

As indicated in the MSD Manuals, the most common symptom is a very severe and evident pain in the groin area after a fall. If the bone fragments have separated (as in a type III or IV injury), the subject will be unable to walk, stand or even move the affected leg.

On the other hand, if the fracture is mild (type I), the patient can try to lead a normal life for a few days, despite the pain. This isn’t at all advisable, as it only leads to an increased risk of death, both in the short and long term.

Possible complications

According to studies, between 2 and 7% of patients die in the acute hospital phase, i.e. shortly after admission. Between 6 and 12% of the elderly who survive this phase die during the first month after the fracture and up to 33% in less than a year.

Thus, the probability of death immediately after the injury is 5-10%, which increases to 1/3 of total patients after one year. Moreover, more than 10% of survivors are completely disabled, with no possibility of returning to their previous residence. Unfortunately, the outlook is bleak.

What’s the reason for this fatal prognosis? Some of the sources already cited explain that this is due to some of the most common complications of hip fractures:

  • Blood clots that form in the legs or lungs: This cuts off normal blood flow, often leading to death.
  • Risk of developing pressure ulcers: Due to the patient being bedridden for a long period of time in a hospital bed. This can lead to systemic infections, which also often results in death in the elderly.
  • Increased loss of muscle mass: Being bedridden, the patient will lose muscle mass, which further hinders their chances of recovery.
  • Infections: Such as urinary tract infections, pneumonia, sepsis.

Diagnosis of a hip fracture

After a serious fall, urgent medical attention is essential, especially if the patient is elderly. The doctor will perform an emergency X-ray, which will show the extent of the fracture.

Depending on the seriousness of the injury, the doctor will decide what interventions to perform.

Surgery after a hip fracture

Despite the data provided so far, a hip fracture in an elderly person is never considered the end of the road. It’s therefore essential to try to address it with surgical treatment.

This is a very delicate process, since, as indicated by the National Library of U.S. Medicine, recovery can take up to a whole year.

Based on the type of fracture, doctors can perform different surgeries. To conclude the article, we’ll give you some details in the final section.

A nurse attends to a woman in hospital.
Prolonged hospitalizations for hip fractures increase the risk of death, so fast resolutions are sought when possible.

1. Screw internal fixation

As described by Central Coast Orthopedic, this surgical procedure uses special metal screws to repair the femoral fracture. The screws may be attached to a metal plate inserted into the bone or on their own; in both cases, they help the tissue reattach.

2. Total hip replacement

The head and neck of the femur and the pelvic bone socket are completely replaced with artificial prostheses. This is the best option in almost all cases; it’s associated with increased quality of life in patients who undergo the procedure.

3. Partial hip replacement

In this case, only the damaged part of the femur is replaced, and not the entire joint. It’s most common for patients who have underlying conditions or who will never be able to live independently.

You may be interested: Ways to Prevent Falls in the Elderly

An injury with a high mortality rate

Unfortunately, if you find out that a loved one has suffered a hip fracture it can be very difficult. Although it’s possible for the patient to recover from a total hip replacement and lead a practically normal life, in many cases this doesn’t happen and the patient dies early.

Beyond the seriousness of the hip fracture itself, the fact that most people affected are elderly and already present underlying conditions prior to the injury complicates the issue. This is why recovery is so costly and the mortality rate so high.