Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

Hip Fracture

For further information, see CMDT Part 41-05: Musculoskeletal Injuries of the Hip

Key Features

Essentials of Diagnosis

  • Internal rotation of the hip is the best provocative diagnostic maneuver

  • Hip fractures should be surgically repaired as soon as possible (within 24 hours)

  • Delayed treatment of hip fractures in the elderly leads to increased complications and mortality

General Considerations

  • Approximately 4% of the 7.9 million fractures that occur each year in the United States are hip fractures

  • Risk factors

    • Osteoporosis

    • Female sex

    • Height > 5-foot 8-inches

    • Age over 50 years

  • Usually occur after a fall

  • High velocity trauma is needed in younger patients

  • Stress fractures can occur in athletes or individuals with poor bone mineral density following repetitive loading activities

Clinical Findings

Symptoms and Signs

  • Pain in the groin is typical, but pain may radiate to the lateral hip, buttock, or knee

  • If a displaced fracture is present, the patient will not be able to bear weight and the leg may be externally rotated

  • Patients with hip stress fractures have less pain on physical examination but typically have pain with weight bearing

Diagnosis

Imaging

  • Radiographic views include anteroposterior views of the pelvis and bilateral hips and frog-leg lateral views of the painful hip

  • CT scan or MRI may be necessary to identify the hip fracture pattern or to evaluate non-displaced fractures

Diagnostic Procedures

  • The Trendelenburg test can be performed to examine for weakness or instability of the hip abductors, primarily the gluteus medius muscle (eTable 41–3)

  • Another functional test is asking the patient to hop or jump during the examination

eTable 41–3.Hip examination.
View Table||Download (.pdf)
eTable 41–3. Hip examination.
Maneuver Description
Inspection Examine for the alignment of the lower extremity, consider lumbar spine exam.
Palpation Include important landmarks: ASIS and AIIS (proximal quadriceps muscle insertions), greater trochanter (gluteal tendon insertions and bursa), anterior femoral triangle (hip joint and hip flexion insertion), ischial tuberosity (hamstring tendon insertion), sacroiliac joints.
Range of motion testing Check range of motion passively (clinician performs) especially internal and external rotation of the hip.
Hip strength testing Test resisted hip flexion, extension, abduction and adduction strength manually.
Trendelenburg test The patient balances first on one leg, raising the non-standing knee toward the chest. The clinician can stand behind the patient and observe for dropping of the pelvis and buttock on the non-stance side.

AIIS, anterior inferior iliac spine; ASIS, anterior superior iliac spine.

Treatment

Surgery

  • Surgery is recommended for almost all patients within the first 24 hours

  • Femoral neck fractures commonly treated with

    • Hemiarthroplasty

    • Total hip ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close