ORTHOPEDICS + SPORTS MEDICINE
Hip Fracture Surgery
Prompt surgical treatment of a broken hip, prioritizing early mobility and a safe return to independence.
A hip fracture can take away a person’s ability to stand or walk in a matter of seconds. Most occur after a fall, particularly in older adults whose bones have weakened, although high-energy injuries can cause the same fracture in younger patients. Surgery is often needed to stabilize or replace the broken portion of the hip so movement can begin as safely and promptly as possible.
Hip fracture care requires decisions to be made quickly, but the operation must still reflect the fracture pattern and the patient’s overall health. Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine evaluates the location of the break, bone quality, joint condition, and pre-injury mobility to determine which surgical approach provides the appropriate stability for recovery.
Anatomy of the Hip Fracture
The hip is a ball-and-socket joint. The femoral head at the top of the thighbone forms the ball, while the acetabulum within the pelvis forms the socket. The femoral neck connects the ball to the main shaft of the thighbone.
Most hip fractures occur in one of two areas:
- Femoral neck fractures develop just below the femoral head and occur within the joint capsule.
- Intertrochanteric fractures occur farther down the upper femur, between the greater and lesser trochanters.
Fractures can also occur below this area in the subtrochanteric region. The fracture’s location affects its blood supply, stability, and the type of repair that may be required.
Signs of a Possible Hip Fracture
A broken hip commonly causes severe pain in the groin or upper thigh and an inability to place weight on the injured leg. The leg may appear shorter or turn outward. Bruising, swelling, and pain with any attempt to move the hip can also occur.
Some fractures are not completely displaced and may produce less dramatic symptoms. A patient might still be able to stand or walk but experience persistent groin or thigh pain after a fall.
A suspected hip fracture requires urgent medical assessment. Patients should not attempt to walk through severe pain or wait for a routine office appointment after an injury that has left them unable to bear weight.
Diagnosing the Fracture
X-rays usually confirm the diagnosis and show where the bone has broken. The images also reveal whether the pieces remain aligned or have shifted out of position.
If symptoms strongly suggest a fracture but X-rays do not show one, MRI or CT imaging may be ordered. These tests can identify a nondisplaced or incomplete fracture that is difficult to see on standard images.
The medical team also evaluates the patient’s general health before surgery. Blood tests, heart testing, medication review, and other assessments help identify conditions that may affect anesthesia, bleeding, or the timing of treatment.
Choosing the Type of Hip Fracture Surgery
The operation depends on the fracture’s location, displacement, and stability. Age, bone strength, arthritis, health, and activity level are also considered.
Internal Fixation
Internal fixation holds the patient’s own bone together while it heals. The surgeon realigns the fracture and stabilizes it with screws, a plate and screws, or a rod placed within the femur.
This approach may be used for selected femoral neck fractures and many intertrochanteric or subtrochanteric fractures. The implant selected depends on the direction of the break and the forces the repair must withstand.
Partial Hip Replacement
A partial hip replacement, or hemiarthroplasty, replaces the damaged femoral head and neck while retaining the natural socket. It may be recommended for a displaced femoral neck fracture when preserving the broken femoral head is unlikely to provide dependable healing.
Total Hip Replacement
Total hip replacement replaces both the femoral head and the socket surface. It may be considered for certain active, independently mobile patients with a displaced femoral neck fracture, particularly when arthritis or joint damage is also present.
The goal is not simply to repair the X-ray. The chosen procedure must provide enough stability for the patient to begin moving while accounting for the condition of the bone and joint.
Why Timely Treatment Matters
Remaining in bed after a hip fracture can contribute to blood clots, pneumonia, pressure injuries, weakness, and loss of independence. For this reason, surgery is generally performed once the patient is medically stable.
Some health concerns may need to be addressed before anesthesia. The orthopedic, medical, and anesthesia teams work together to balance the need for timely surgery with the patient’s immediate safety.
Treatment does not end in the operating room. Preventing complications and beginning rehabilitation are essential parts of hip fracture care.
Recovery Begins With Movement
Patients are often helped out of bed and begin standing or walking shortly after surgery. A walker or other assistive device provides support while strength and balance are limited.
How much weight can be placed on the leg depends on the fracture and the operation performed. A stable replacement or fixation may permit earlier weight bearing, while some repairs require greater protection.
Early recovery may include:
- Medication for pain control
- Measures to reduce the risk of blood clots
- Incision monitoring
- Breathing and circulation exercises
- Assistance with transfers and walking
- Planning for a safe discharge environment
Some patients return home with support. Others need short-term rehabilitation or skilled nursing care before they can safely manage daily activities.
Physical and Occupational Therapy
Physical therapy helps restore walking, leg strength, balance, and endurance. The therapist also teaches the patient how to use a walker or cane and navigate stairs safely.
Occupational therapy focuses on daily tasks such as dressing, bathing, toileting, and moving around the home. Equipment or temporary changes to the living environment may be recommended.
Rehabilitation is influenced by the patient’s strength and independence before the fracture. Older adults may need continued support even after the bone or surgical incision has healed. Fall prevention and treatment for osteoporosis may also be included in the long-term plan.
When to See a Hip Specialist
Seek immediate medical care when a fall or other injury causes severe hip or groin pain, an inability to stand, or a leg that appears shortened or rotated. Sudden loss of mobility should be treated as a possible fracture even if there is little bruising.
New calf swelling, chest pain, shortness of breath, fever, drainage from the incision, or increasing pain after surgery also requires prompt medical attention.
Summary
Hip fracture surgery creates the stability needed for rehabilitation, but the broader objective is to help the patient regain safe movement and as much independence as possible. The type of fracture, pre-injury function, general health, and commitment to therapy all influence that process.
Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine coordinates surgical treatment with postoperative rehabilitation and ongoing fracture care, allowing each patient’s recovery plan to address both the repaired hip and the factors that may affect future mobility.