Hip Fractures: The What, The Why and The Fix

By Hodari Brooks, MD

As a board certified orthopedic surgeon practicing in the greater Atlanta area I have the opportunity to treat hip fractures on a fairly regular basis. While this is a very common injury among the elderly population it can occur in younger individuals as well. I have been surprised about the significant amount of misinformation and confusion regarding hip fractures. This article will address the common causes, types and treatment of hip fractures.

The Why – the main reasons that hip fractures occur is because our bones become more and more weakened as we grow older. This condition of weakened bone is called osteoporosis. This leads to an increased risk of developing a broken hip even after a relatively minor fall. The reason these fractures tend to occur more in elderly women than in men is because of the lack of estrogen after menopause that occurs in women. Estrogen has many effects, one of which is to help protect bone. Thus women who do not take estrogen after menopause are at increased risk of developing hip fractures. (There are both positive and potential negative aspects of estrogen therapy so you should discuss your individual case with your doctor). These fractures can also occur in younger patients after major injury such as falling from a roof or being involved in a car accident.

The What– This is the area where perhaps there is the most confusion. Most people feel that all hip fractures are the same. This is not true and the type of fracture significantly affects the treatment options. (1) Femoral Neck fractures – this is perhaps the most common type and occurs when the hip breaks right below the “ball” of the ball and socket joint of the hip. (2) Inter-trochanteric fractures – in this type the break occurs right below the femoral neck area. It is important to indicate that not all types of fractures within these groups are the same. Some are simple and involve only two main parts and some are complex – meaning that the bone has broken into multiple parts. Thus people have to be careful not to compare their hip fracture results with other individuals because not all hip fractures are the same.

The Fix - with femoral neck fractures the treatment depends on the age of the patient. In younger patients (typically less than 50) we will often attempt to fix the fracture with screws. For this to be effective the quality of the bone has to be good and the patent has to be able to use crutches for 6 weeks. In older individuals, where the bone is of relatively poor quality, the treatment typically involves a partial hip replacement. This allows for immediate weight bearing. In some cases where the patient has pre-existing arthritis of the hip a total hip replacement is performed for definitive treatment. For patients with intertrochanteric fractures, fixation of the fracture is the typical treatment. Usually either a trochanteric “rod” which goes down the center of the bone or a plate and screws placed on top of the bone are used to treat this injury.
In closing I would like to remind my readers to have a high degree of suspicion for hip fractures in your elderly family members after a fall. If one develops significant hip pain after a major trauma then I would consider the hip broken until proven otherwise. Yes, I do know that a late night trip to the emergency room is not what we look forward to, however, it can actually be very important to allow the appropriate treatment to begin.