Hip fractures can be a serious health concern and will continue to increase in number as our population ages. In 2002, approximately 350,000 people were hospitalized for hip fractures, but experts predict the number will soar to 650,000 per year by 2050.

There are two types of hip fractures. The first one is known as an intertrochanteric fracture, which occurs below the hip about three to four inches from the joint. This area of the hip heals well, but the bones must be stabilized while healing. If the bones aren’t stabilized surgically during the healing process, patients require prolonged bedrest. The other type is a femoral neck fracture and occurs near the upper part of the femur about one to two inches from the socket of the hip joint.

This area doesn’t heal well.

Risk Factors
It’s fairly common knowledge that older individuals tend to fracture their hips more often than younger people. In the case of severe trauma such as a car accident, younger patients can break their hip, whereas older patients can break a hip simply by falling or moving wrong. Statistically, however, the following groups are more likely to experience a hip fracture:

• Women have two to three times as many hip fractures as men.
• White, post-menopausal women have a one in seven chance of hip fracture during their lifetime.
• Women 5’ 8” and over have twice the risk of women 5’ 2” and under.
• People over age 50 have an increased risk.

The lifetime risk of breast cancer is comparable to the lifetime likelihood of a hip fracture. Although women are reminded to do breast self-exams and get periodic mammograms, it’s likewise important to consider bone density tests as part of a woman’s preventive health care.

Treatment and Recovery
Nearly all hip fractures are surgically treated. In fact, in most cases, the risks of not treating a hip fracture are greater than the risks of surgery. The ultimate goal of any treatment is to help the patient return to as much mobility as possible, with the least amount of pain.

Treatment for a femoral neck fracture depends on several factors, including the patient’s age, general health, activity levels, and how far the bone has moved out of place. Younger, active patients—or those whose bone isn’t significantly displaced—are typically treated by stabilizing the bones with surgical screws or pins. Older, less active patients—or those whose bone is severely displaced—may require a partial or total hip joint replacement.

Intertrochanteric fractures usually are treated with surgical pins or rods and screws. This often is referred to as “internal fixation” and provides the stabilization needed while healing.

Physical therapy is an important part of a patient’s post-surgery recovery. Well-trained physical therapists can help you learn to walk with a cane, walker, or crutches, as well as work with you to strengthen your muscles. Unfortunately, not everyone regains independence at the same rate. In fact, it’s quite common for older adults who break a hip to spend time in a skilled nursing facility or rehabilitation center following surgery. Temporary use of ambulatory aids such as walkers, canes, and crutches is expected following a hip fracture and surgery. In some cases, patients may use these indefinitely; one reason for ongoing use of ambulatory aids is to provide additional stability and hopefully prevent another fall and fracture.

A Wake-Up Call
Breaking a hip should be a sign to a patient that she may have osteoporosis. Therefore, as a follow-up to a hip fracture, it’s wise to have bone density evaluated to prevent another broken bone. A bone density test is a painless, non-invasive procedure often covered by Medicare.

Because a hip fracture can have serious consequences, patients and their families should take measures to prevent falls and fractures:

• Make sure all stairs have sturdy handrails.
• Be sure steps aren’t comprised of a slippery material and that people aren’t in the habit of leaving items on the steps.
• Periodically check the soles of shoes to make sure they still have good traction.
• Remove any loose rugs.
• Don’t make sudden moves—to answer the door, pick up a falling object, or prevent a spill. A little milk on the floor is less important than preventing a broken hip.
• Clean up spills promptly.
• Arrange cabinets and closets so items are within easy reach.
• Wear your glasses or use your cane if you need them; you may not like the way they look, but they help you remain safe.
• Install safety bars in the shower; regular towel racks aren’t sturdy enough to prevent a fall if you slip.
• Put slip-proof mats in your shower or tub.
• Make sure entryways, hallways, stairways, and bathrooms are well lit.
• Don’t carry too many items when going up or down stairs.
• Be sure to have easy access to phones in an emergency. This could be a portable phone, a cell phone you wear on your belt, or an emergency alert wristband.
• Eat regular meals so you don’t become lightheaded or dizzy. TPW