Hip and Pelvic Fractures
Hip and pelvic fractures are both serious and painful injuries that require quick-care orthopedic injury treatment to prevent permanent damage to the bone or surrounding soft tissues.
What Is The Difference Between Hip and Pelvis?
The hip joint is a ball-and-socket joint between the pelvis and femur, and the pelvis is a large bone structure located in the lower part of the body. The hip joint connects the pelvis and femur, and the pelvis connects the spinal column and legs.
What Is a Hip Fracture?
A hip fracture occurs when there is an injury to the upper part of the femur, which may involve the femoral head, the femoral neck or the trochanter.
As stated previously, the hip is a ball-and-socket joint between the pelvis and the femur; the femoral head is the rounded top of the femur, which fits snugly into a cup-shaped area of the pelvis, called the acetabulum; the femoral neck is below the femoral head and connects to the main part of the femur; and the trochanter is a bony ridge that provides an attachment point for muscles supporting the hip joint.
What Is the Most Common Site of Hip Fractures?
The most common site of hip fractures is the femoral neck. Women are more likely than men to fracture this part of the hip as a result of a fall or due to having low bone density (chances increase for women over age 60 due to osteoporosis).
Other common sites of hip fractures include the femoral head and the trochanter. Femoral head fractures are commonly associated with a dislocated hip in which the femur is pulled out of the acetabular socket. These injuries often occur as a result of a high-impact car crash. This type of fracture is also common for people who have osteoporosis–a stress fracture or insufficiency fracture that occurs when weakened bones crack under the stress of everyday movements, such as walking or climbing stairs.
A fracture that occurs between the femoral neck and the trochanter is called an intertrochanteric fracture. A fracture that occurs below the trochanter is called a subtrochanteric fracture. These types of fractures are usually the result of a direct blow to this part of the hip due to a fall.
Are There Different Types of Hip Fractures?
There are three main types of hip fractures:
Displaced Fracture. The fracture is displaced when separated into two or more pieces that don’t remain in place.
Nondisplaced Fracture. The fracture is nondisplaced when the pieces of broken bone don’t separate.
Stress or Insufficiency Fracture. The fracture is limited to a tiny crack or cracks in the bone.
X-rays and other diagnostic tests can confirm which type of fracture you may have.
What Are the Symptoms of a Hip Fracture?
Symptoms of a hip fracture vary depending on the severity of the injury and the location of the break. Most people experience significant sharp pain in the hip or groin and may not be able to put any weight on the affected hip. They may also notice swelling, redness, or bruising in the skin above the injury.
What Is a Pelvic Fracture?
A pelvic fracture occurs when there is an injury to any of the large butterfly-shaped group of bones–the ilium, ischium, and pubis–located at the base of the spine. Ligaments attach this ring of bones to the sacrum at the lower part of the spine. On each side of the pelvis, the cup-shaped socket called the acetabulum connects with the femoral head to form the hip joint.
Pelvic fractures may involve the ilium, ischium and pubis, and acetabulum.
Ilium Fracture. The two largest pelvic bones are round, flat bones called ilia. They resemble a butterfly’s wing and are located on either side of the body above the legs.
This fracture often results from falls or other accidents.
Ischium and Pubis Fractures. Below each ilium is a ring-shaped structure composed of the ischium and pubis bones. These fractures often result from falls or other accidents.
Acetabulum Fracture. The acetabulum is the socket located on each side of the pelvis. This fracture usually occurs as the result of a car accident or fall from a significant height with damage to other bones and soft structures in and around the hip and pelvis.
Pelvic Stress Fracture. This type of fracture usually develops as a result of repetitive, high impact activity that puts stress on the pelvis, such as long-distance running or ballet. This type of fracture is also common for people with osteoporosis.
What Are Symptoms of a Pelvic Fracture?
Who Is At A Higher Risk for Hip and Pelvic Fractures?
Hip and pelvic fractures commonly occur in people older than age 60 as a result of falls. Postmenopausal women who have osteoporosis, a condition that weakens the bones, are most vulnerable. In athletes, repeated high-impact activity may cause a stress fracture, which is a tiny crack in the hip or pelvic bone.
What Causes Hip and Pelvic Fractures?
How Are Hip and Pelvic Fractures Diagnosed?
While evaluating your injury, your doctor may ask you about the location and severity of pain you’re experiencing, how the injury occurred, your medical history, and other medical conditions you may have like osteoporosis. Your doctor will also conduct a physical exam of the affected hip or pelvic bone to assess the extent of swelling, bruising, and tenderness, and will confirm a diagnosis of whether or not you have a fracture with imaging tests. Imaging tests, such as an X-ray, will help determine the location of a fracture, how many bones are affected, and whether an injury has damaged surrounding soft tissues, such as tendons, ligaments, blood vessels, or nerves.
CT scans may also be ordered to examine a fracture pattern or assess the extent of damage in the hip joint. It may also reveal the presence of small bone fragments that would need to be removed surgically. Sometimes an MRI or bone scan may be ordered to look for small hairline fractures.
This information will help your doctor make the best choice for your care.
How Are Hip and Pelvic Fractures Treated?
These are usually recommended when hip or pelvic fractures are nondisplaced, meaning the bone fragments remain in place. In that regard, your doctor may recommend any one of the following:
Activity Modification. You will need to modify your activity where you don’t put any weight on the affected hip for 6 weeks or more to allow the bone to heal. To help you get around during this time period, you may use crutches, a walker, a cane, or a wheelchair. While you are recovering, it is important that you remain active so blood clots don’t form in your leg. You will then want to do stretching and range-of-motion exercises to maintain strength and improve blood flow, which stimulates healing.
Electronic and Ultrasonic Bone Stimulation. These forms of bone stimulation help to speed bone healing, using either a low electric current or low-intensity pulsed sound waves to stimulate your body to produce proteins that begin to repair cells at the site of the injury. These treatments are usually done in the office, but for patients that have a fracture that is slowly healing, they can be issued a portable unit for home use.
Physical Therapy. After the injured hip or pelvic bone begins to heal, a physical therapist will work with you to teach you exercises to help preserve range-of-motion and strength in the joints and muscles surrounding the injury. These exercises will help to increase blood flow and deliver more oxygen and nutrients to the injured parts of the bone, and aid in healing.
Pain Medication. Pain medication may be prescribed for the first 1 – 2 weeks after your injury, and then you would use over-the-counter medications to help alleviate pain.
Note that your doctor may recommend that you avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) after a hip or pelvic fracture because inflammation is an important part of the body’s healing process. Taking NSAIDs may delay bone healing.
Surgery is usually done for hip fractures. You usually won’t need surgery to fix a pelvic fracture unless it’s a severe one.
Surgery is often performed to reduce the fracture, stabilize the bone, and repair soft tissue structures. The following procedures are often recommended to ensure a full recovery and to prevent further joint damage.
Reduction and Fixation Surgery. Broken bones in the hip and pelvis need to be set and stabilized in order to heal fully. Reduction sets the bone or reassembles the bone fragments. Fixation prevents bone fragments from moving while new bone tissue grows, and fuses the pieces into one solid bone.
Open and Closed Reduction. In a closed reduction, the surgeon makes small incisions near the broken bone and uses surgical instruments to reassemble the bone fragments. This procedure is often recommended for simple fractures that don’t involve many bone fragments and haven’t broken the skin. This technique speeds healing and is a less invasive procedure with minimal damage to surrounding soft tissues.
In an open reduction, the surgeon makes an incision over the injured area to view the pieces of broken bone and assesses how well they can be put back together. Open reduction is required for open fractures where a bone breaks through the skin. An open reduction may also be recommended when fractured bones have broken into many pieces, are displaced or out of position.
Internal and External Fixation. After the fractured bone has been reduced, a surgeon uses one or more fixation devices to keep the bone fragments in position while the bone heals. Based on the location and severity of the fracture, the surgeon determines which device to use. Internal fixation involves using stainless steel screws, plates, wires, and rods to fix the bone fragments together permanently. With an external fixation device, the surgeon inserts metal pins into the bone on each side of the hip or pelvic fracture, then connects those pins to a frame that extends outside the body.
Hip Replacement Surgery
Hip replacement surgery is often recommended for patients who 1) have a serious fracture of the femur where reduction and fixation don’t stabilize the bones; or 2) have a fracture that has severely affected the function of the hip. In such cases, durable prosthetic parts (made from metal or ceramic) are used to replace the injured ball and socket components of the joint. Depending on the extent of the injury, patients may have either a partial or total hip replacement.
What Is the Recovery Time After Hip and Pelvic Fractures?
Generally, it takes several months to recover from a broken hip or pelvis. For a hip fracture, you may need to be in the hospital or in a rehab facility until you can walk well again.
After hip surgery, you will need physical therapy. These exercises will help make your hip stronger and help you get back to normal.
What Precautions Can You Take To Prevent Hip Fractures?
People who have osteoporosis should eat a nutritious diet with plenty of protein, calcium, and vitamin D to strengthen their bones. They should also keep taking their prescribed medicines or supplements throughout their recovery period.
Go To Ortho provides full-service trauma care. We are board certified orthopedic surgeons with privileges at all major hospitals in Portland, including some surgery centers. Come to see us for your quick-care orthopedic injury needs. Walk-in appointments are welcome or you may request an appointment on our homepage or call us at (503) 850-9950..