Hip Fracture
It is a fracture of the femur bone, specifically the part of the femur that connects with the pelvic bone.
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A hip fracture is a serious injury that mainly affects older people following a fall. In Canada, a hip fracture occurs every 15 minutes. Although treatment is surgical, physical therapy rehabilitation plays a key role in regaining mobility and independence. If you or a loved one is going through this ordeal, 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, near the hip joint. It mainly affects elderly people following a fall and usually requires surgery followed by rehabilitation.
Types of fractures
There are three main types of hip fractures, classified according to their location:
| Type | Location | Features |
|---|---|---|
| Femoral neck fracture | In the joint (intracapsular) | May compromise blood flow to the femoral head |
| Intertrochanteric fracture | Between the greater and lesser trochanter | The most common, good vascularization |
| Subtrochanteric fracture | Under the lesser trochanter | Less frequent, longer consolidation |
Anatomy of the hip
The femoral neck is the narrow part that connects the head of the femur (the ball that articulates in the pelvis) to the rest of the bone. This area supports much of the body's weight when walking.
With age and osteoporosis, the femoral neck becomes more fragile and vulnerable to fractures, even during low-impact falls.
What causes a hip fracture?
The main cause is a fall in a person with bones weakened by osteoporosis. In older people, even a low-impact fall can cause a fracture. Major trauma causes fractures in younger people.
Risk factors
Several factors increase the risk of hip fracture:
- Osteoporosis: Loss of bone density weakens bones
- Advanced age: Over 80% of fractures occur in people aged 65 and over.
- Female gender: 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 problems: Increase the risk of falling
- Medications: Some medications cause dizziness.
Injury mechanism
The vast majority of hip fractures occur when a person falls from standing height. The person falls on their side and the direct impact on the hip causes the fracture.
In younger people, a hip fracture 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 severe 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 external rotation of the foot.
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
- Leg that appears shorter than the other
- Foot pointing outward (external rotation)
- Swelling or bruising on the hip
When to call emergency services
Call 911 immediately if:- Severe hip pain after a fall
- Inability to stand up or move the leg
- Visible deformation of the leg
- The person is confused or has lost consciousness.
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How is a hip fracture treated?
Treatment is surgical in the vast majority of cases. Depending on the type of fracture and the patient's condition, either osteosynthesis (fixation with screws or plates) or hip replacement surgery is performed. The procedure is an emergency.
Surgical emergency
Surgery should ideally 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 for falls in Canada involved a hip fracture. This represents more than 26,000 hospitalizations per year.
Surgical options
| Option | Indication | Recovery |
|---|---|---|
| Osteosynthesis (screws/plates) | Stable fractures, not displaced | Gradual loading, 2-3 months |
| Partial denture | Displaced neck fractures, less active patients | Immediate loading, 6-12 weeks |
| Total prosthesis | Active patients, pre-existing osteoarthritis | Immediate loading, 6-12 weeks |
Hospitalization
Hospitalization lasts an average of 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 physical therapy after a hip fracture?
Physical therapy is essential for regaining mobility and independence after a hip fracture. It begins the day after surgery and includes mobilization, muscle strengthening, and walking training.
Early mobilization
Research clearly demonstrates the importance of moving early after surgery. Patients who begin intensive physical therapy (3 sessions per day) meet the criteria for discharge from the hospital 10 days earlier 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 objectives are:
- Regaining the ability to walk: First with a walker, then a cane, then without assistance
- Strengthen muscles: Quadriceps, glutes, and hip muscles
- Improving balance: Reducing the risk of further falls
- Resuming daily activities: Stairs, hygiene, dressing
Evidence
The guidelines from the Academy of Orthopaedic Physical Therapy (2021) recommend:
- Daily mobilization starting the day after surgery
- Progressive high-intensity strengthening exercises
- Balance and walking training
- Home exercise program
Programs lasting 12 to 24 weeks show the best results for functional recovery.
How does rehabilitation work?
Rehabilitation takes place in three phases: acute (early mobilization in 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, the day after surgery:
- Transfers: Learning how to move safely from bed to chair
- First steps: Walking with a walker under supervision
- Bed exercises: Ankle pumps, quadriceps contractions
- Compliance with restrictions: Follow the surgeon's instructions on weight bearing.
Phase 2: Intermediate (2-8 weeks)
Often in a rehabilitation center or at home with follow-up care:
- Progressive walking: From walker to cane, increasing distances
- Strengthening: Exercises for quadriceps and glutes
- Balance: Standing exercises with support
- Stairs: Learning with a handrail under supervision
Phase 3: Advanced (8+ weeks)
The goal is to return to maximum independence:
- Independent walking: Without technical assistance if possible
- Intensive strengthening: Resistance exercises
- Functional exercises: Simulating daily activities
- Fall Prevention: Long-Term Balance Program
| Phase | Duration | Main objectives | Location |
|---|---|---|---|
| Acute | 0-2 weeks | Mobilization, transfers, first steps | Hospital |
| Intermediate | 2-8 weeks | Strengthening, walking with assistance, stairs | Rehabilitation center or home |
| Advance | 8+ weeks | Independence, fall prevention | Outpatient clinic or home |
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Book an appointmentHow long does recovery take?
Bone healing takes approximately 3 months. Full functional recovery varies from 6 weeks to 6 months after prosthetic surgery, and up to one year after osteosynthesis. Approximately 50% of patients do not regain their pre-fracture level of function.
Factors that influence recovery
Several factors affect the speed of recovery:
- Age and pre-fracture condition: Younger, more active individuals recover better.
- Type of surgery: Prostheses allow for faster weight bearing
- Participation in rehabilitation: Active involvement speeds up recovery
- Health conditions: Diabetes, heart disease, or dementia slow down the process.
Realistic forecast
It is important to have realistic expectations while remaining hopeful. Statistics show that:
- Only 45% of women are still alive 5 years after a hip fracture.
- Half of survivors do not regain their pre-fracture abilities.
- Less than 15% of nursing home residents regain their ability to walk.
These figures highlight the importance of intensive rehabilitation and adequate support. With a well-structured physical therapy program, many patients exceed these statistical averages.
How can hip fractures be prevented?
Prevention is based 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
The majority of hip fractures result from falls. To prevent them:
- Balance exercises: Tai chi, one-leg exercises, walking
- Strength training: Leg exercises 2-3 times per week
- Vision correction: Annual exam, up-to-date eyeglasses
- Home adaptations: Adequate lighting, fixed rugs, grab bars
- Drug review: Some cause dizziness
Strengthen bones
To prevent osteoporosis and strengthen bones:
- Screening: Bone densitometry recommended after age 65
- Treatment: Medication if necessary (reduces risk by 40%)
- Calcium and vitamin D: Adequate intake through diet or supplements
- Physical activity: Weight-bearing exercise stimulates bone formation.
Conclusion and next steps
A hip fracture is a serious injury, but significant recovery is possible with prompt treatment and sustained rehabilitation. Physical therapy 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 physical therapists can assist you with your rehabilitation, either in the clinic or at home. The earlier and more intensive the rehabilitation, the better the results.
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