Fractures of the Hip: Types, Causes, Clinical Features, Diagnosis & Management

Fractures of the Hip: Types, Causes, Clinical Features, Diagnosis & Management

Introduction

Hip fractures are serious injuries that commonly occur in the elderly but can affect all age groups. They involve a break in the proximal femur and often lead to significant morbidity, disability, and increased mortality if not treated promptly. Early diagnosis and timely management are crucial for restoring mobility, reducing complications, and improving functional outcomes.

Fractures of hip


Types of Hip Fractures

Hip fractures are broadly classified into intracapsular and extracapsular fractures.

1. Intracapsular Fractures

These occur within the capsule of the hip joint.

a. Subcapital Fracture

  • Just below the femoral head.

  • High risk of avascular necrosis (AVN).

b. Transcervical Fracture

  • Through the neck of the femur.

c. Basicervical Fracture

  • At the base of the femoral neck.

Complications:
High chances of disrupted blood supply → AVN & non-union.

2. Extracapsular Fractures

These occur outside the joint capsule.

a. Intertrochanteric Fracture

  • Between the greater and lesser trochanter.

  • Better blood supply → lower risk of AVN.

b. Subtrochanteric Fracture

  • Below the lesser trochanter.

  • High biomechanical stress → delayed healing common.

Causes

1. In Elderly

  • Osteoporosis (most common)

  • Minor falls

  • Weak musculature and poor balance

2. In Young Adults

  • High-energy trauma (RTAs, falls from height)

  • Sports injuries

3. Pathological Fractures

  • Malignancy

  • Bone cysts

  • Metabolic bone disease

Clinical Presentation

Patients typically present with:

  • Severe hip/groin pain

  • Inability to bear weight

  • Shortened and externally rotated leg

  • Swelling and tenderness around hip

  • Painful hip movements

  • In subtrochanteric fractures → deformity may be severe

Diagnosis

1. X-Ray

  • Anteroposterior (AP) pelvis

  • Cross-table lateral view

2. CT Scan

  • For unclear fracture patterns

3. MRI

  • Useful for detecting occult fractures

  • Assesses vascularity of femoral head (AVN risk)

Management of Hip Fractures

Management depends on patient age, fracture type, displacement, and comorbidities.

A. Initial Emergency Management

  • Immobilize limb

  • Pain control (NSAIDs, opioids)

  • IV fluids (for elderly with dehydration)

  • Thromboembolism prophylaxis

  • Pre-operative assessment (ECG, labs)

B. Definitive Management

1. Intracapsular Fractures

a. Non-displaced fractures

Treatment: Internal Fixation

  • Cannulated screws

  • Dynamic Hip Screw (DHS)

b. Displaced fractures in elderly

Treatment: Arthroplasty

  • Hemiarthroplasty

  • Total Hip Replacement (THR)
    (THR preferred for active individuals)

c. Displaced fractures in young adults

Urgent internal fixation within 6 hours to preserve femoral head blood supply.

2. Intertrochanteric Fractures

Preferred Treatment: Surgical Fixation

  • Dynamic Hip Screw (DHS)

  • Proximal Femoral Nail (PFN)

PFN is preferred for unstable or reverse-obliquity fractures.

3. Subtrochanteric Fractures

Treatment Options:

  • Long Proximal Femoral Nail (PFN-Long)

  • Intramedullary nailing

  • Plates in rare cases (when nailing not possible)

Postoperative Rehabilitation

1. Early Phase (0–2 Weeks)

  • Pain management

  • Static quadriceps exercises

  • Ankle pumps

  • Gentle ROM of hip (as per surgeon limits)

2. Intermediate Phase (2–6 Weeks)

  • Progressive weight-bearing (if allowed)

  • Strengthening of hip abductors

  • Gait training with walker/crutches

3. Late Phase (6–12 Weeks)

  • Full weight-bearing (for many fracture types)

  • Strength training for hip and core muscles

  • Balance and proprioception exercises

Complications

  • Avascular necrosis (AVN)

  • Non-union or malunion

  • Deep vein thrombosis (DVT)

  • Infection

  • Implant failure

  • Post-traumatic arthritis

Prognosis

  • Early surgery within 24–48 hours improves outcomes.

  • Mortality is significantly higher if treatment is delayed in elderly patients.

  • Rehabilitation is essential for return to pre-injury mobility.

PubMed References

(You may add these in Scribd/Blog for credibility)

  1. Parker MJ & Gurusamy K. "Internal fixation vs arthroplasty for intracapsular hip fractures." Cochrane Review, 2023.

  2. Bhandari M et al. "Operative management of hip fractures in adults." J Bone Joint Surg Am.

  3. Haidukewych GJ. "Intertrochanteric fractures: ten tips to improve results." J Bone Joint Surg Am.

  4. Zlowodzki M et al. "Subtrochanteric femur fractures." Injury.


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