I’m Ed Smith, a Sacramento Bone Fracture Attorney. Anyone who has paid attention to the television recently has probably seen numerous commercials with elderly people falling and saying that they “cannot get up.” While some people may look upon these commercials with a skeptical eye, in reality, they shine light on a very important issue. When it comes to bone fractures, hip fractures are among the most common and serious bone fractures in the medical community. Because of their implications for patient movement and the quality of life issues that they can create, it is important for patients to understand how a hip fracture develops, what problems it can cause, and how a fractured hip is treated.What is a Fractured Hip?
When patients are told that they have suffered a broken hip, most patients assume this simply means a fracture in the hip; however, there are multiple types of hip fractures that can develop. They have been classified in this manner because each type of hip fracture has a different set of treatment implications and set of complications that could develop. There are three different types of hip fractures, including:
An Intracapsular Hip Fracture: The hip is made up of the femoral head that inserts into the acetabulum, or the hip socket, and provides the ball and socket joint movement that most people are familiar with. Just beneath the femoral head is a thin zone called the femoral neck. If the break in the hip occurs in the femoral neck, this is called an intracapsular hip fracture. These types of fractures are relatively common because the bone is particularly thin in the femoral neck.
An Intertrochanteric Fracture: Below the femoral head and the femoral neck is an area of the femur called the greater trochanter, on the lateral side, and the lesser trochanter, on the medial side. These are two bony projections that come off of the femur. If a fracture develops in between (or completely through) the greater and lesser trochanter, this is termed an intertrochanteric fracture. Because the bone is thicker in this region, it typically requires a greater amount of force to cause this type of fracture.
A Subtrochanteric Fracture: This type of fracture encompasses any fracture that develops beneath the greater and lesser trochanter. Every patient’s anatomy is slightly different; however, after a certain point down the femur, the fractures will be classified as femur fractures instead of hip fractures.
It is important for patients to understand that while the fractures are certainly classified in this manner, it is possible for patients to suffer multiple hip fractures of various types if the accident was particularly severe. One fracture can also span multiple classifications.How do Hip Fractures Develop?
When people suffer a broken hip, many want to know exactly how their fracture developed so that they can prevent it from returning once it’s treated. Most hip fractures develop from a fall or from a direct impact to the hip. Because the femoral head, neck, and trochanteric region are particularly thick in size, most hip fractures develop in the elderly. Over time, bones start to lose their calcium density, weakening their structure. If the bones become too weak, people may be told they have osteopenia or osteoporosis, the medical terms for weak bones. This can predispose people to developing fractures and both conditions are more common in the elderly. Because elderly individuals both fall more often and have weaker bones, they are predisposed to hip fractures. When people fall, they can impact their hip directly, leading to a fracture in any one of the three regions discussed above.
In addition to falls, people can also suffer hip fractures in traumatic accidents. For example, if someone is involved in a car accident, their car could be t-boned by another vehicle. This could lead to the door of the car directly impacting the hip, leading to a fractured hip. Another mechanism of injury in a car accident involves a head on collision. People typically have their legs extended at the front of the vehicle as they try to slam on the breaks to stop the car. If the front of the car impacts another vehicle, the front of the car could get rolled up, along with the driver’s legs. If the driver’s legs are locked in place when the impact occurs, the force of the impact could be transmitted all the way up the femur and into the hip, causing a hip fracture.
These are only a couple of the mechanisms that could lead to a hip fracture; however, they are the most common. No matter the mechanism of injury, a hip fracture is always a serious injury that deserves expert medical attention.What Kind of Symptoms Will I Experience?
After the physician has completed the medical history of the accident, they will want to ask about the symptoms that the patient has been experiencing. If people have a broken hip, there are a few different symptoms that they should keep an eye out for. While some of these symptoms are common across all fractures, some are unique to the hip and can help lead to a quicker diagnosis. Some of the symptoms of a fractured hip include:
Trouble Moving or Walking: Because the hip is an intricate part of the walking mechanism, patients will have difficulty walking. Every time the ball and socket joint moves to initiate a step, patients will feel pain in the affected hip. This will make walking almost impossible. Patients may even feel the crack in their hip move.
Pain over the Fracture Site: In this case, patients will feel pain in their hip regardless of whether or not they are walking. If they touch the fracture site, the pain will get worse. This is the most common symptom of a hip fracture.
Inability to Place Weight on the Leg: On the fractured side, patients will be unable to bear weight. This includes standing up or placing pressure on the bottom of the foot of the fractured hip. For example, patients may have trouble even putting on their shoe because of the pressure this places on the leg of the fractured hip.The Physical Exam of a Broken Hip
After the physician has finished asking questions, they will proceed to the physical exam. They will certainly take a look at the patient’s heart rate and blood pressure; however, they will focus their exam on the site of the fractured hip. There are a few physical exam findings that the physician will be looking for, including:
Swelling and Bruising: When patients suffer a fractured hip, the hip tends to swell up. This is body responding to the fracture by mobilizing cells and plasma to the injured hip to initiate the repair process. In addition, the hip is a vascular structure filled with blood vessels. If any of these vessels have been damaged, patients may also start to notice bruises in the area. If this is the case, patients should seek medical attention quickly in case a major blood vessel has been damaged.
The Fractured Hip May Appear Shorter: It is possible that the leg on the side of the fracture may appear shorter. If a complete break has been suffered, the muscles of the hip will pull on the broken fragment and may dislocate the broken fragment upward. This gives the appearance of a shorter leg and is a common occurrence after a traumatic accident, such as an auto collision.
The Fractured Hip May Turn Outward: Similar to the symptom above, the muscles will also turn the broken fragment toward the lateral side, or outward, in a complete break. The physician will look for these two signs to confirm the diagnosis. They also will indicate a severe, complete, break.Will I Need to Receive Any Imaging Studies?
After the history and physical have been completed, the physician will order a few imaging studies. Even if the fracture has been confirmed on a physical exam, these studies are still going to be necessary because the exact location of the fracture needs to be identified and there may be other fractures present in other bones that need to be treated.
An X-Ray: The physician will likely order an x-ray from multiple different angles, such as the AP and lateral angles. This is necessary because some locations of the hip are only visible from certain angles and fractures could be missed if these angles aren’t included in the order. An x-ray is a fast, safe scan that can be used to quickly identify almost every type of bone fracture. Patients will be asked to move or hold their hip in certain locations to facilitate the different angles of the x-ray. The x-ray may include the leg as well, particularly if the patient was involved in a traumatic accident, to ensure there aren’t other femur fractures that have been missed.
An MRI: This study will not be ordered in every situation; however, if the patient has suffered a complete break or there are concerns that ancillary structures have been damaged (such as muscles or nerves), this study may be ordered to get a better look at these structures. An MRI takes longer to complete, making it a secondary modality for emergent situations; however, it provides impressive detail and doesn’t expose the patient to any radiation. Patients just need to remove any metal prior to receiving this scan. If patients have metal implants, they cannot receive an MRI scan.
These are the two most common imaging modalities employed for hip fractures; however, patients could be asked to undergo an ultrasound scan in the emergency room or a CT scan for other injuries.What About the Possibility of Surgery?
Surgery is not necessary for every hip fracture; however, it is not uncommon for patients to require surgery to repair a fractured hip. The imaging studies will tell the physician whether or not the fracture has been displaced. If the fracture has been displaced, the bone is not in a proper location to heal correctly. Therefore, the bones will need to be placed back in their proper alignment through a surgical procedure. A surgeon will put the bones back into place and then hold the bones in place using pins, screws, or plates that will remain in place for life.
Some patients may have ligaments or tendons that have been torn in a traumatic accident. If this is the case, surgery will be needed to repair these structures as well.Rehabilitation May Be Necessary
Almost every patient who suffers a broken hip will require some degree of rehab as they learn how to walk on their newly repaired hip; however, rehab could range from simply moving a stiff hip that has been in a cast for several week to re-learning how to walk altogether. Most patients will have at least a few visits with a physical therapist who will work on strengthening the muscles around the hip to prevent another hip fracture and helping to restore balance and flexibility over the injured leg.Complications of a Hip Fracture
Without a doubt, the most dangerous complication that can develop from a fractured hip is called avascular necrosis. Sometimes, the fragments of the bone can tear off and damage the blood vessels that supply oxygen to the hip. If this happens, the bone will start to die, giving the injury the name avascular necrosis. When this happens, this is a surgical emergency because blood flow to the hip must be restored. Sometimes, the hip has already suffered too much damage and the patient could require a hip replacement.
Other common complications include damage to surrounding ligaments and tendons, infection after surgery, and possible blood clots from an immobilized leg. Patients should be sure to have prophylactic treatment for blood clots during and after surgery.Contact an Experienced Bone Fracture Attorney
I’m Ed Smith, a Sacramento Bone Fracture Attorney. A hip fracture is a common but serious injury that deserves the attention of qualified medical professional. Anyone who has suffered a hip fracture in an accident may call me at (916) 921-6400 for free, friendly advice. You may also use my toll-free line at (800) 404-5400 when calling outside the Sacramento region.
I am a member of the California Million Dollar Advocates Forum. Members in our forum are top injury lawyers who have obtained settlements or verdicts in excess of 1 Million Dollars.
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Photograph: Sacramento Personal Injury Lawyer, Edward A. Smith
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