Hip / Femoral Neck Fracture

A hip fracture is a break of the upper end of the thigh bone, close to where it joins the pelvis. It is among the most serious injuries of later life and is almost always treated with an operation. This page covers what happens, how doctors choose treatment and what care in turkey can and cannot offer.

What is a hip fracture?

The thigh bone (femur) ends in a rounded ball that sits in the pelvic socket. Just below the ball is the narrow neck of the femur, and below that the bony prominences called trochanters. A break anywhere in this region is called a hip fracture, though the joint surface itself is usually intact.

The name in your notes may be more specific. A femoral neck fracture is a break through the neck, and an intertrochanteric or subtrochanteric fracture lies lower down. Each behaves differently, which is why the label affects the plan.

Who is affected by a hip fracture?

Most people who break a hip are over 65 years of age, and the risk climbs sharply after 80. Women are affected more often than men, mainly because osteoporosis (thinning bone) is more common after the menopause. The typical cause is a fall from standing height onto weak bone.

Younger people can also break a hip. It generally takes a high-energy event such as a road crash, a fall from a height or a heavy sports collision. In these cases the bone is usually healthy, and surgeons work hard to save the natural joint.

How serious is a hip fracture?

It is serious. Many people lose some independence after the injury. In frail older adults a hip fracture is linked with a higher risk of death in the following year. Fast surgery, early walking and good rehabilitation make a measurable difference.

Urgent local treatment is the priority. The later sections explain the types of break, how doctors diagnose them, the operations used and the long road to recovery.

The hip carries the weight of your whole upper body, so the bone near the joint is under constant strain. Knowing the anatomy shows why some breaks are far more serious than others.

How is the upper femur built?

The femoral head is a ball of about 4.5 to 5 cm across, covered by smooth cartilage. It connects to the shaft by the femoral neck, which angles inward at roughly 125 degrees. Below the neck are the greater trochanter on the outer side and the lesser trochanter on the inner side. Powerful muscles attach to both.

The inside of the bone is spongy (cancellous) bone arranged in struts that line up with the forces of walking. A thin shell of hard cortical bone surrounds it. With age and osteoporosis the struts thin out and the shell becomes fragile.

Why does blood supply matter?

The ball receives much of its blood from small vessels that run up along the neck, close to the bone. When the neck breaks and the pieces separate, these vessels can tear or twist. The ball may then lose its blood supply, a problem called avascular necrosis (bone death). It is described in more detail on the page about avascular necrosis of the hip.

That is why a displaced neck break is often treated by replacing the ball. Breaks lower down, in the trochanteric region, have a richer blood supply and tend to heal with metal fixation.

What changes when the bone breaks?

When the femur breaks, the muscles pull the leg upward and outward. The limb looks shorter and the foot rotates outward. Bleeding into the surrounding tissue causes swelling and bruising, which can take several days to appear. The joint capsule, labrum and cartilage may also be hurt. A broken hip hurts to move at all, and bearing weight on it is usually impossible.

Hip fractures are classified by where the bone breaks and whether the pieces have moved. The type decides the operation, the timing and the recovery plan, so it is the first thing the surgical team works out from the X-ray.

What is a femoral neck fracture?

A femoral neck fracture is an intracapsular break, meaning inside the joint capsule, in the narrow neck beneath the ball. It is the pattern most associated with a damaged blood supply. A common grading is the Garden classification, which runs from stage 1 (incomplete or impacted, stable) to stage 4 (fully displaced, with the ball completely separated).

Undisplaced breaks may be pinned with screws to hold them in place. Displaced breaks in older adults are usually treated by replacing the ball with a prosthesis, as described later.

What are intertrochanteric and subtrochanteric fractures?

Intertrochanteric fractures run between the two trochanters, outside the joint capsule. Subtrochanteric fractures lie just below the lesser trochanter. Both have a better blood supply than neck fractures. They are typically fixed rather than replaced, using a sliding screw and plate or an intramedullary nail that runs down the inside of the bone.

Which stable and unstable patterns are there?

A fracture is called stable if the fragments will support each other after fixation. It is unstable if they will not, for example when there are several pieces. A crushed back wall of the bone has the same effect. Unstable breaks need stronger devices, and recovery may be slower.

Why does classification change the plan?

Surgeons weigh fracture type against age, bone quality, previous activity and general health. The aim is the operation that gets you walking soonest and is least likely to need repeating. A fit 60-year-old with a displaced neck fracture and a frail 90-year-old with the same X-ray may be offered different treatment.

A hip fracture is diagnosed in an emergency department from the story of the injury, a physical examination and X-rays. The speed of the diagnosis matters, because surgery cannot begin until the fracture is confirmed and the patient is prepared.

What does the clinical assessment include?

Staff ask how the fall happened and whether there was a blackout, dizziness or chest pain beforehand. A fall caused by a heart rhythm problem, infection or low blood pressure needs treating alongside the bone. They note your usual walking ability, who you live with and your medicines, because these shape the surgical and rehabilitation plan.

On examination the leg may be shortened and turned outward, with severe pain on any attempt to move it. The team checks the pulse and sensation in the foot, looks for other injuries such as a wrist fracture or a head injury, and screens for confusion.

Which imaging is used for a broken hip?

A plain X-ray of the pelvis and the hip, from the front and the side, confirms most fractures. If the X-ray is normal but pain and inability to walk persist, an MRI scan is requested. Sometimes a CT scan is used instead. Both can detect hidden cracks within hours. This matters, as an undisplaced break can become displaced if the patient walks on it.

What tests are done before surgery?

Blood tests check blood count, kidney function, salts and clotting. An ECG and chest assessment may be needed, and an anaesthetist reviews your heart, lungs and medicines. Pain relief begins in the emergency department, often with a nerve block that numbs the hip area for several hours.

What should be gathered for a later remote review?

Are you considering care after the initial emergency, for example for a fracture that has not healed? Then collect your operation note, the implant sticker or record, all X-ray and CT images as DICOM files, discharge summaries and your list of medicines. Our medical record review guide explains how records are used, and you can send them through the free case review form. This applies to planned follow-on care only, never to an acute break.

Surgery is the standard treatment for almost every hip fracture, so non-surgical care is the exception. When it is used, the goal is comfort and safety rather than healing the break to a normal shape.

Is any hip fracture treated without surgery?

A few people are treated without an operation. They include people so frail or unwell that anaesthesia carries a very high risk, those already bedbound, and some with a stable stress fracture. In these cases the aim is pain control, nursing care and the avoidance of complications of lying in bed.

Lying in bed for weeks leads to pressure sores, chest infections, blood clots and rapid muscle loss, so non-surgical treatment of a displaced break carries its own serious risks. This is why surgeons recommend surgery even for very frail patients when it can be done safely, often mainly for pain relief.

How is pain managed?

Treatment begins with simple medicines such as paracetamol (acetaminophen), then stronger opioid painkillers when needed, with care in older adults because of drowsiness and constipation. A nerve block, which numbs the area around the hip, is a safe and effective option in the emergency department and can greatly cut the need for strong medicines.

Inflammatory painkillers are used with caution, as they can affect the kidneys and stomach in older people. Your team chooses and times the doses, so follow their instructions.

What is the role of rehabilitation before surgery?

Before the operation, nurses and physiotherapists position the leg comfortably, protect the heels and encourage deep breathing. Fluids, nutrition and treatment of any infection are begun straight away. Hospital teams aim for an operation within 24 to 48 hours of arrival, and delay is only accepted to stabilise a serious medical problem.

What about a stress fracture?

An incomplete break of the neck, for instance in a distance runner or a person with osteoporosis, can sometimes be managed by protected weight-bearing on crutches for about 6 to 8 weeks. Because such fractures may suddenly displace, many surgeons recommend pinning the bone with screws. Follow-up imaging is essential.

What does the evidence say?

Studies comparing early surgery with delay or with non-operative care favour surgery within about 48 hours. This holds for people who are fit enough, in terms of pain, mobility and complications. Medicines for bone strength and exercise, discussed later, are an addition to surgery, not a replacement for it.

Hip fracture surgery either fixes the broken bone with metal or replaces the damaged ball with a prosthesis. The choice depends on the fracture type, the quality of the bone and your general health and activity level.

How does hip fracture surgery by fixation work?

In hip fracture surgery the surgeon realigns the pieces and holds them with implants. For a break between the trochanters the usual devices are a sliding hip screw with a side plate, or an intramedullary nail. The nail is passed down the centre of the bone, with a screw into the ball. Undisplaced neck breaks and breaks in younger people may be fixed with several screws.

The advantage is that your own joint is kept. The disadvantage is that the bone must heal. A minority of fractures fail to unite or lose their blood supply. A second operation, often a replacement, is then needed. You can read about hip fracture surgery in turkey and how the hip fracture surgery cost guide works.

When is a hemiarthroplasty used?

A hip hemiarthroplasty replaces only the ball (femoral head and neck) with a metal prosthesis, and leaves the patient's own socket in place. It is a common treatment for a displaced femoral neck fracture in older adults. This is especially so for those who walk little or have memory problems. The operation is shorter and dislocates less often than a full replacement.

Patients are encouraged to stand and walk with support on the first day. Read more about hip hemiarthroplasty in turkey and the hip hemiarthroplasty cost guide.

When is a total hip replacement used?

A total hip replacement swaps both the ball and the socket. For a displaced neck fracture it is generally offered to people who were active, walking well and mentally alert before the injury, and in whom the socket already shows arthritis. Studies suggest that it can give better function over time than a hemiarthroplasty in this group, with a somewhat higher risk of dislocation.

It is also the usual operation when an earlier fixation has failed or when arthritis has followed an old fracture. See total hip replacement in turkey and the total hip replacement cost guide.

What about the type of anaesthesia?

Many hip fracture operations are done with spinal anaesthesia, which numbs the lower body while the patient stays awake or lightly sedated. General anaesthesia is also used. The anaesthetist chooses based on your heart, lungs and preferences.

Many hip fractures can be prevented by keeping bones strong and avoiding falls. Prevention is worth discussing with your doctor early, long before an injury occurs, and it is essential after a first break.

How do you keep bones strong?

Weight-bearing exercise such as walking, plus resistance work, builds and maintains bone. Eat enough calcium and protein and keep vitamin D at healthy levels, with supplements if your doctor advises them. Stop smoking and keep alcohol low. Review long-term steroid use with your doctor.

A DEXA bone density scan identifies osteoporosis, and treatments such as bisphosphonates and other bone-building drugs lower fracture risk. People who have broken one hip should be assessed, as the risk of a second fracture is high in the following years.

How do you lower the risk of falling?

Balance and strength classes, tai chi and physiotherapy programmes reduce falls in older adults. Have your eyes checked every year, ask a pharmacist to review medicines that cause dizziness, and treat low blood pressure and foot problems. Use a walking aid if you are unsteady, and wear supportive shoes.

What home changes help?

Fit grab rails, remove trip hazards, improve lighting and keep a phone within reach. Night lights between bed and bathroom are valuable. Where the risk is high, hip protectors worn in a care home may lower the chance of a break for some people, though they are often hard to keep wearing.

What cannot be prevented?

Serious high-energy accidents and some falls cannot be avoided, and age and genetics affect bone strength. The aim is to lower the odds as far as possible, and to be ready for quick treatment if a fracture happens. Families can help by learning the warning signs listed earlier.

Recovery from a hip fracture is a long process, and the outlook depends strongly on your health and independence before the injury. Most people walk again, but many need support for months and some do not return to their former level.

What is hip fracture recovery time?

Hip fracture recovery time is best thought of in stages. Most people leave hospital after about 4 to 7 days, either home with support or to a rehabilitation unit. Walking with a frame or sticks usually improves over the first 6 to 12 weeks. By 3 to 6 months many people are close to their best. Strength, balance and confidence can keep improving for up to 12 months.

Will I walk normally again?

Many people regain walking, although a sizeable share need a stick or frame afterwards and some lose independence. Those who were active before the injury, who are not confused and who start walking early tend to do best. Younger people with a fixed fracture often return to near-normal activity.

When can I drive, work or travel?

Most people are advised to wait about 6 to 8 weeks to drive, depending on the side operated on and the vehicle, and only when they can brake safely. Desk work may resume within 2 to 3 months, and physical work later. Flying is usually possible after several weeks with surgeon approval and blood-clot precautions.

What about long-term life after a hip fracture?

The first year carries higher risks, particularly in frail older adults, so follow-up and rehabilitation matter. The most important long-term step is to treat osteoporosis and reduce falls, which lowers the chance of a second break. Many people live well for many years after recovery, helped by exercise, good nutrition and support from family and community services.

Look after the other hip, too. If pain or stiffness appears in either hip over time, a review of hip dysplasia and arthritis as causes may be sensible.