Hip Fracture

What is a hip fracture?

The term “hip fracture” refers to a fracture of the proximal femur, in the region close to the hip joint. Depending on the exact location of the fracture in relation to the joint capsule, fractures fall into two main categories, with important differences in treatment:

• Intracapsular fractures (femoral neck / subcapital fractures): These lie within the joint capsule, close to the femoral head. Their important feature is that they may disrupt the blood supply to the femoral head, with a risk of subsequent avascular necrosis.
• Extracapsular fractures (intertrochanteric): These lie slightly more distally, outside the joint capsule, in the region of the trochanters. Here the blood supply to the head is, as a rule, not at risk.

This distinction is decisive, as it determines the type of surgical treatment.

Causes and risk factors

In older people, a hip fracture is usually caused by a simple fall, with osteoporosis, which makes the bone fragile, as the underlying factor. Other risk factors include balance disorders, impaired vision, muscle weakness and certain medications.

In younger people, a hip fracture is rarer and is, as a rule, caused by high-energy trauma, such as a road traffic accident or a fall from a height.

Clinical picture – Symptoms

The symptoms of a hip fracture are, as a rule, severe and clear:

• Severe pain in the hip or groin, especially on attempting to move.
• Inability to bear weight and walk — the patient usually cannot put weight on the limb.
• Characteristic position of the leg: the affected leg often appears shortened and externally rotated.
• Swelling and tenderness in the area.

In some undisplaced fractures, the patient may retain some ability to bear weight, which is why any persistent hip pain after a fall must be investigated.

Diagnosis

The diagnosis is made by clinical examination and radiographs (X-rays) of the hip and pelvis, which show the fracture and its type. In some cases of undisplaced fractures that are not clear on the radiograph, a CT or MRI scan is required for confirmation. A full preoperative work-up — laboratory, cardiological and anaesthetic — is essential, especially in older patients.

Treatment

In the great majority of cases, a hip fracture is treated surgically and without delay, as delay significantly increases the risk of complications from bed rest. The type of operation depends on the type and location of the fracture, as well as on the age and activity level of the patient:

• Internal fixation: In extracapsular (intertrochanteric) fractures and in some undisplaced femoral neck fractures, the fracture is stabilised with metal implants (screws, plates or intramedullary nails), preserving the natural joint. In certain undisplaced subcapital fractures, closed reduction and percutaneous fixation (screw fixation) is performed, while in extracapsular fractures the method of choice is closed reduction and stabilisation with intramedullary nailing.
• Hemiarthroplasty: In displaced subcapital fractures in older patients, where the blood supply to the head has been disrupted, the femoral head is replaced.
• Total hip replacement: In more active patients with a displaced subcapital fracture or pre-existing arthritis, the entire joint is replaced.

In subcapital fractures of the femur that are treated with hip replacement, Dr. Tsarouhas uses — in selected cases — the ASI method (Anterior Supine Intermuscular), which, thanks to the preservation of the muscles, allows faster mobilisation — a critical factor for older patients.

The importance of prompt treatment

In older people, a hip fracture is not simply an orthopedic problem — it is a condition that affects overall health and survival. Prolonged bed rest is associated with serious complications, such as thrombosis, chest infections and pressure sores. For this reason, the modern approach emphasises surgical treatment within 24–48 hours (where the patient’s condition allows) and immediate mobilisation, so that the patient gets back on their feet as soon as possible.

At the same time, treatment of the underlying osteoporosis is essential for the prevention of further fractures.

Rehabilitation

Rehabilitation begins immediately after the operation, with the aim of the fastest possible mobilisation. The physiotherapy programme focuses on gait retraining (initially with a walking aid), muscle strengthening and the restoration of balance and independence. The pace depends on the type of fracture, the type of operation and the general condition of the patient. In older people, support and the prevention of further falls are an important part of care.

Prevention of hip fractures

In older people, prevention of hip fracture focuses on two areas: treatment of osteoporosis (with medication and adequate intake of calcium and vitamin D, where indicated) and the prevention of falls. Fall-prevention measures include creating a safe home environment (removing rugs, good lighting, grab rails in the bathroom), checking vision, reviewing medicines that cause dizziness and strengthening the muscles through exercise.

Cost of treatment

The cost depends on the type of fracture and the type of operation (internal fixation, hemiarthroplasty or total hip replacement), the materials, the hospital and the length of stay, as well as the insurance cover. As it is often an emergency, it is covered in most cases by insurance funds and private insurance policies.

Precise information is given on an individual basis. The practice is at your disposal for any relevant information.

More on the factors that determine the cost and on cover by insurance funds: Cost of surgery.

Holistic care of the older patient

The treatment of a hip fracture in an older person does not end in the operating theatre. These are patients who often have other health problems as well, which is why their care requires a holistic approach: proper pain management, prevention of the complications of bed rest, nutritional support, treatment of osteoporosis and organised rehabilitation.

The aim is not only healing of the fracture, but the patient’s return to their previous level of independence and quality of life. Close cooperation between the orthopedic surgeon, the other specialists and the patient’s family is important in achieving this aim.

Rehabilitation and return to independence

Rehabilitation after a hip fracture begins immediately after the operation, with the aim of the fastest possible mobilisation. The physiotherapy programme focuses on gait retraining — initially with a walking aid — on muscle strengthening and on the restoration of balance.

In older patients, the aim is a return to the previous level of independence. Psychological support, encouragement and the prevention of further falls are an important part of this process. The active participation of the patient and the support of the family are decisive for successful rehabilitation.

Frequently asked questions

Does a hip fracture always need surgery?

In the great majority of cases, yes — and without delay. Surgical treatment allows rapid mobilisation and drastically reduces the risk of serious complications from bed rest.

What is the difference between intracapsular and extracapsular fractures?

Intracapsular fractures (femoral neck / subcapital) lie within the capsule and may disrupt the blood supply to the head, so they are often treated with hip replacement. Extracapsular fractures (intertrochanteric) are usually treated with internal fixation.

How quickly should surgery be performed?

The modern approach emphasises surgical treatment within 24–48 hours, where the patient’s condition allows, as delay increases the risk of complications.

Can the ASI method be used?

Yes, in selected cases of subcapital fractures treated with hip replacement, the ASI method allows faster mobilisation thanks to the preservation of the muscles.

Why is treating osteoporosis important?

Because osteoporosis is the underlying cause of most hip fractures in older people. Treating it is essential for the prevention of further fractures.

Is the cost covered by insurance?

As it is often an emergency, it is covered in most cases by insurance funds and private insurance policies. The practice can give you detailed information.

Does the patient recover fully after a hip fracture?

Many patients regain their mobility, especially with prompt surgical treatment and proper rehabilitation. The outcome depends on the general condition before the fracture, the type of fracture and adherence to the rehabilitation programme.