What Is a Hip Fracture?

A hip fracture is a break in the upper portion of the femur (thigh bone), near the hip joint. The hip is a ball-and-socket joint, where the rounded femoral head fits into the acetabulum of the pelvis. While this structure allows for a wide range of motion, it can also be vulnerable to fracture, especially in weakened bone.

Although commonly associated with older adults and osteoporosis, hip fractures can occur at any age due to high-energy trauma such as:

• Falls
• Motor vehicle accidents
• Sports injuries
• Direct impact to the hip
• Severe twisting injuries

Most hip fractures occur in elderly patients whose bones have been weakened by osteoporosis. Each year, more than 300,000 people in the United States sustain a hip fracture, most of whom are adults over age 65 injured during a fall.

It is important to note that fractures of the acetabulum (the hip socket) are classified as pelvic fractures, though both are serious orthopedic injuries.

Types of Hip Fractures

Hip fractures are categorized based on their location along the femur.

1. Intracapsular (Femoral Neck) Fractures

These occur within the joint capsule at the femoral neck. Because blood supply to the femoral head may be disrupted, these fractures carry a higher risk of complications such as avascular necrosis (osteonecrosis).

Femoral neck fractures may be:

• Displaced
• Nondisplaced

Stress fractures of the femoral neck can occur from repetitive impact, particularly in distance runners.

2. Intertrochanteric Fractures

These fractures occur between the greater and lesser trochanters. They are common in older adults after a fall and are typically treated surgically.

3. Subtrochanteric Fractures

These occur just below the lesser trochanter and involve the upper portion of the femoral shaft. They are often associated with high-energy trauma or weakened bone.

Femoral Shaft Fractures

A femoral shaft fracture is a break along the long portion of the thighbone. Because the femur is the strongest bone in the body, significant force is usually required to cause this injury.

Common patterns include:

• Transverse
• Oblique
• Spiral
• Comminuted
• Open fracture (bone protrudes through the skin)

Femoral shaft fractures are orthopedic emergencies and typically require surgical stabilization.

Hip Dislocations

A hip dislocation occurs when the femoral head is forced out of the acetabulum.

• Posterior dislocation (most common): Often seen in car accidents.
• Anterior dislocation: Less common, usually caused by forceful external rotation.

Hip dislocations require urgent reduction, ideally within several hours, to reduce the risk of nerve injury or osteonecrosis.

Symptoms of a Broken Hip

Common symptoms include:

• Severe hip or groin pain
• Inability to bear weight
• Shortened or externally rotated leg
• Swelling or bruising
• Visible deformity (with dislocations)
• Pain with movement

Some patients with weakened bone may experience groin or thigh pain for weeks before a complete fracture occurs.

Emergency Room Evaluation

When a patient presents with a suspected hip fracture, rapid assessment is critical.

Evaluation includes:

• Detailed medical history
• Physical examination
• Neurovascular assessment
• Imaging studies

Imaging

• X-rays to confirm fracture location
• MRI for stress or occult fractures
• CT scan for complex injuries

Prompt diagnosis allows for early surgical planning and helps reduce complications.

Treatment for Hip Fractures and Trauma

Most hip fractures require surgical intervention. Treatment depends on fracture type, patient age, bone quality and overall health.

Surgical Fixation (Internal Fixation)

Used when the bone can be preserved.

• Surgical screws
• Compression hip screws with plates
• Intramedullary nails
• Open reduction and internal fixation (ORIF)

Prompt surgical treatment allows earlier mobilization and reduces the risk of complications such as blood clots, pneumonia and pressure injuries.

Partial Hip Replacement (Hemiarthroplasty)

Replaces the femoral head while preserving the socket. Often used for certain displaced femoral neck fractures in older adults.

Total Hip Replacement (Total Hip Arthroplasty)

Recommended when there is severe joint damage, pre-existing arthritis or a non-repairable fracture. Both the femoral head and acetabulum are replaced with prosthetic components.

Nonsurgical Treatment

In select patients with limited mobility prior to injury or significant medical risks, nonsurgical management may be considered.

Recovery After Hip Fracture Surgery

Recovery varies based on injury severity and procedure.

Initial Recovery

• Hospital stay of several days
• Pain management
• Early mobilization (often beginning the day after surgery)
• Blood clot prevention

Rehabilitation

• Physical therapy
• Gait training
• Gradual return to weight-bearing
• Occupational therapy for activities of daily living

Many patients return home after surgery, while others may require short-term rehabilitation care.

Bone healing typically takes about three months. Full recovery may take six to twelve months.

Potential Complications

Early treatment reduces the risk of:

• Post-traumatic arthritis
• Osteonecrosis
• Blood clots
• Infection
• Nerve injury
• Nonunion or malunion

Structured rehabilitation improves long-term outcomes.

Who Is at Higher Risk?

Risk factors include:

• Osteoporosis
• Advanced age
• History of falls
• Long-term steroid use
• Alcohol use disorder
• High-impact trauma

Preventive strategies include bone density evaluation, fall prevention and strength training.

When to Seek Immediate Care

Seek emergency care if you experience:

• Inability to stand or bear weight
• Severe hip pain
• Visible deformity
• Leg shortening or rotation
• Hip pain after significant trauma

Prompt evaluation reduces the risk of long-term complications.

Comprehensive Hip Trauma Care at OrthoTexas

Hip fractures and traumatic hip injuries can significantly affect mobility and independence. At OrthoTexas, our orthopedic trauma and hip specialists provide:

• Rapid diagnostic evaluation
• Advanced surgical expertise
• Minimally invasive fixation when appropriate
• Coordinated rehabilitation planning
• Personalized recovery programs

Our goal is to stabilize your injury, protect long-term joint health and restore safe, functional movement.