Types Of Hip Fractures: A Comprehensive Guide

Medically Reviewed by Dr Wang Lushun

MBBS (Singapore)

MRCS (Edin)

MMed (Ortho)

FRCS (Ortho) (Edin)

What are Hip Fractures?

A hip fracture is a break in the upper thigh bone (femur), typically near the hip joint. These fractures are common, particularly among the elderly, and they can range from minor to severe. As people age, bones may weaken due to conditions like osteoporosis, making them more susceptible to fractures from falls or minor trauma. This type of injury is serious and often requires immediate medical attention.

Types of Hip Fractures

Hip fractures are classified based on their anatomical location and severity. They fall into two main categories: intracapsular fractures and extracapsular fractures.

Intracapsular Fractures

Intracapsular fractures occur within the hip joint capsule, including the femoral neck. These fractures can disrupt the blood supply to the head of the femur, which can complicate healing. The most common type of intracapsular fracture is the femoral neck fracture.

Femoral Neck Fracture
A femoral neck fracture occurs just below the ball of the ball-and-socket hip joint. This type of fracture can be classified as displaced (where the bone pieces are out of alignment) or non-displaced (where the bone remains aligned). Displaced fractures are more serious as they compromise the blood supply and may require joint replacements. Non-displaced fractures can heal with surgical fixation.

Extracapsular Fractures

Extracapsular fractures occur outside the hip joint capsule and typically involve the upper portion of the femur. These fractures are less likely to disrupt the blood supply than to intracapsular fractures but can still lead to complications. The two main types of extracapsular fractures are intertrochanteric fractures and subtrochanteric fractures.

Intertrochanteric Fracture
An intertrochanteric fracture occurs between the greater and lesser trochanters, which are bony projections on the upper femur. These fractures are commonly caused by falls and are usually treated with surgical fixation.

Subtrochanteric Fracture
A subtrochanteric fracture occurs below the lesser trochanter, typically in the area between the lesser trochanter and the midsection of the femur. These fractures are more challenging to treat because they involve a part of the bone that bears significant stress and weight during movement. They typically require surgical fixation.

Symptoms of Hip Fractures

Hip fractures typically cause sudden and intense pain in the hip or groin area, especially after a fall or trauma. Common symptoms include:

Inability to move the leg: The affected leg may feel immobile or too painful to move as the broken bone prevents normal function.

Shortened or outwardly rotated leg: The leg on the side of the fracture may appear shorter or turned outward due to muscle contraction around the broken bone.

Swelling or bruising: Visible swelling, bruising, or tenderness may occur around the hip or groin area as a result of internal bleeding or tissue damage from the fracture.

Difficulty walking or standing: Most people with a hip fracture will find it hard or impossible to bear weight on the injured leg because of the pain and instability caused by the break.

Treatment Options for Hip Fractures

The treatment for hip fractures is determined by the type of fracture, the patient’s age, and overall health. Treatment aims to relieve pain, restore mobility, and prevent complications.

Non-Surgical Treatment Options

Hip fractures are usually treated surgically. Non-surgical treatments may be used for patients who are unable to undergo surgery due to other health conditions. These options include:

Traction

Traction involves applying a gentle pulling force to align the bones during healing. In some cases, traction is used to keep the bones aligned during healing.

Bed Rest and Pain Management

For minor fractures or patients with severe health issues, doctors may recommend bed rest and pain relief through medication to allow natural healing. However, this approach carries risks such as muscle weakness, blood clots, and reduced mobility, especially in older adults, necessitating close monitoring.

Surgical Treatment Options

Surgery is typically required for most hip fractures, especially for displaced fractures or fractures that affect stability.

Internal Fixation

Metal screws, plates, or nails/rods are used to hold the broken bone in place while it heals. This method is commonly used for femoral neck or intertrochanteric fractures. The surgeon inserts screws or nails/rods to stabilise the bone, allowing the bone to heal around these supports. This approach helps to restore mobility, often followed by physical therapy.

Total Hip Replacement

A total hip replacement replaces both the ball and the socket of the joint. This surgery is often recommended for active older adults with severe fractures or damage from conditions like arthritis. Recovery from hip replacement typically involves physical therapy and may take several months. Enhanced recovery techniques have been adopted to aid faster recovery in weeks.

Hemiarthroplasty

This is a partial hip replacement where the procedure involves replacing only the head of the femur with a femur implant. This is often used for displaced femoral neck fractures where blood supply to the bone is compromised. It allows patients to bear weight and move the hip joint sooner than with other treatments, reducing the risk of long-term immobility. It is suitable for elderly patients who are less active.

Conclusion

Hip fractures are a serious injury, especially for older adults, and can affect mobility and quality of life. Recognising the types, symptoms, and treatment options is necessary for prompt and effective care. Whether through surgery or non-surgical interventions, treatment aims to restore mobility and prevent further complications, offering the best chance for recovery.

If you’re concerned about a hip injury or fracture, schedule a consultation with Dr LS Wang to receive expert care and personalised treatment options for a faster recovery. Dr LS Wang is a hip specialist in direct anterior and direct superior hip replacements and specialises in enhanced recovery after surgery.

Our Clinic Locations

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3 Mount Elizabeth, #13-14
Mount Elizabeth Medical Centre
Singapore 228510
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820 Thomson Road, Mount Alvernia Hospital, #05-51, Medical Centre D, Singapore 574623

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