Hip Fracture

A hip fracture is a serious injury that primarily affects older adults following a fall. In Canada, a hip fracture occurs every 15 minutes. While surgical treatment is necessary, physiotherapy rehabilitation plays a crucial role in regaining mobility and independence. If you or a loved one is experiencing this, know that significant recovery is possible with the right care.

What is a Hip Fracture?

A hip fracture is a break in the upper part of the femur (thigh bone), near the hip joint. It primarily affects older adults after a fall and usually requires surgery followed by rehabilitation.

Types of Fractures

There are three main types of hip fractures, classified by their location:

Hip Anatomy

The femoral neck is the narrow part that connects the head of the femur (the ball that fits into the hip socket) to the rest of the bone. This area supports a large portion of the body's weight when walking.

With age and osteoporosis, the femoral neck becomes more fragile and prone to fractures, even from low-impact falls.

What Causes a Hip Fracture?

The main cause is a fall in someone with bones weakened by osteoporosis. For older individuals, even a low-impact fall can cause a fracture. Major traumas are typically the cause of fractures in younger people.

Risk factors

Several factors increase the risk of hip fracture:

• Osteoporosis: Loss of bone density weakens the bones
• Advanced Age: Over 80% of fractures occur in individuals aged 65 and older
• Female Sex: Women are more affected, especially after menopause
• History of falls: A previous fall increases the risk
• Muscle Weakness: Reduces the ability to prevent falls
• Balance Disorders: Increase the risk of falling
• Medications: Some medications can cause dizziness

Mechanism of Injury

The vast majority of hip fractures occur during a fall from standing height. The person falls to the side, and the direct impact on the hip causes the fracture.

In younger individuals, a hip fracture typically requires a more significant trauma, such as a car accident or a fall from a height.

What are the Symptoms of a Hip Fracture?

A hip fracture causes intense pain in the hip or groin, an inability to stand up or put weight on the leg, and often a visible shortening of the leg with the foot turned outward.

Typical Signs

After a fall, the following signs suggest a hip fracture:

• Severe pain in the hip or groin
• Inability to stand up or walk
• One leg appears shorter than the other
• Foot pointing outwards (external rotation)
• Swelling or bruising in the hip

When to call emergency services

• Severe hip pain after a fall
• Inability to stand up or move the leg
• Visible leg deformity
• The person is confused or has lost consciousness

How is a hip fracture treated?

In the vast majority of cases, treatment involves surgery. Depending on the type of fracture and the patient's condition, either osteosynthesis (fixation with screws or plates) or a hip replacement is performed. The surgery is an emergency.

Surgical emergency

Ideally, surgery should take place within 24 to 48 hours of the fracture. A longer delay increases the risk of complications such as infections, blood clots, and delirium.

In 2019-2020, 34% of hospitalizations due to falls in Canada involved a hip fracture. This accounts for over 26,000 hospitalizations annually.

Surgical Options

Hospitalization

Hospitalization typically lasts 10 to 15 days. During this time, the medical team monitors recovery, and rehabilitation begins immediately.

Patients hospitalized for a hip fracture stay approximately 3 days longer than those without a fracture.

What is the role of physiotherapy after a hip fracture?

Physiotherapy is essential for regaining mobility and independence after a hip fracture. It begins the day after surgery and includes mobilization, muscle strengthening, and gait training.

Early Mobilization

Research clearly shows the importance of moving early after surgery. Patients who start intensive physiotherapy (3 sessions per day) meet hospital discharge criteria 10 days sooner than those who have one session per day.

Early mobilization also prevents complications such as:

• Blood clots (venous thrombosis)
• Pneumonia
• Pressure sores
• Muscle loss

Rehabilitation Goals

The main goals are:

• Regain the ability to walk: First with a walker, then a cane, then without assistance
• Strengthen muscles: Quadriceps, glutes, and hip muscles
• Improve balance: Reduce the risk of new falls
• Resume daily activities: Stairs, hygiene, dressing

Evidence

The Academy of Orthopaedic Physical Therapy (2021) guidelines recommend:

• Daily mobilization starting the day after surgery
• Progressive, high-intensity strengthening exercises
• Balance and gait training
• Home exercise program

Programs lasting 12 to 24 weeks show the best results for functional recovery.

How does rehabilitation proceed?

Rehabilitation takes place in three phases: acute (early mobilization in the hospital), intermediate (strengthening and walking with assistance), and advanced (return to independence). The total duration varies from 3 to 6 months, depending on age and health status.

Phase 1: Acute (0-2 weeks)

This phase begins in the hospital, starting the day after surgery:

• Transfers: Learning to safely move from bed to a chair
• First steps: Walking with a walker under supervision
• Bed Exercises: Ankle pumps, quadriceps contractions
• Following Restrictions: Adhere to the surgeon's instructions regarding weight-bearing

Phase 2: Intermediate (2-8 weeks)

Often in a rehabilitation center or at home with supervision:

• Progressive Walking: From walker to cane, increasing distances
• Strengthening: Exercises for quadriceps and glutes
• Balance: Standing exercises with support
• Stairs: Learning to use stairs with a handrail under supervision

Phase 3: Advanced (8+ weeks)

The goal is to return to maximum independence:

• Independent Walking: Without assistive devices if possible
• Intensive Strengthening: Exercises with resistance
• Functional Exercises: Simulating daily activities
• Fall Prevention: Long-term balance program

How long does recovery take?

Bone consolidation takes about 3 months. Full functional recovery ranges from 6 weeks to 6 months after a prosthesis, and up to one year after osteosynthesis. Approximately 50% of patients do not regain their pre-fracture level.

Factors influencing recovery

Several factors affect the speed of recovery:

• Age and Pre-Fracture Condition: Younger and more active individuals tend to recover better
• Type of surgery: Prostheses allow for faster weight-bearing
• Participation in rehabilitation: Active engagement speeds up recovery
• Health conditions: Diabetes, heart disease, or dementia slow down the process

Realistic prognosis

It's important to have realistic expectations while maintaining hope. Statistics show that:

• Only 45% of women are still alive 5 years after a hip fracture
• Half of survivors do not regain their abilities from before the fracture
• Less than 15% of residents in care facilities regain their ability to walk

These figures highlight the importance of intensive rehabilitation and adequate support. With a well-structured physiotherapy program, many patients exceed these statistical averages.

How to prevent hip fractures?

Prevention relies on strengthening bones, improving balance, and reducing the risk of falls at home. Strength and balance exercises reduce the risk of falls by 30 to 40%.

Preventing falls

Most hip fractures result from falls. To prevent them:

• Balance exercises: Tai chi, single-leg exercises, walking
• Muscle strengthening: Leg exercises 2-3 times per week
• Vision correction: Annual exam, up-to-date glasses
• Home adaptation: Adequate lighting, fixed rugs, grab bars
• Medication review: Some medications cause dizziness

Strengthening bones

To prevent osteoporosis and strengthen bones:

• Screening: Bone densitometry recommended after age 65
• Treatment: Medications if necessary (reduce risk by 40%)
• Calcium and vitamin D: Adequate intake through diet or supplements
• Physical activity: Weight-bearing stimulates bone formation

Conclusion and next steps

A hip fracture is a serious injury, but significant recovery is possible with prompt care and ongoing rehabilitation. Physiotherapy begins the day after surgery and continues for several months to maximize the chances of regaining independence.

If you or a loved one has suffered a hip fracture, our physiotherapists can support you through your rehabilitation, whether in the clinic or at home. The earlier and more intensive the rehabilitation, the better the results.