making the diagnosis

Hip fractures are usually easy to diagnose.  Typically the patient has a fall and can’t walk afterwards.  The pain is most often located in the groin, it is made worse by any attempt at range of motion of the hip, and in certain cases, the leg is obviously in the wrong position.  Emergency medical services are usually summoned, the patient is taken to the hospital, and a series of x-rays will often reveal the fracture.  Here is a picture from the Google body browser showing the location of one of the most common types of hip fractures, a fracture of the femoral neck.  This fracture occurs through the base of the ball and socket joint of the hip.

Many patients and their families want to know why such a simple fall can result in such a serious hip fracture.  In most cases, the bones are osteoporotic and very weak before the fall, and the elderly often have less muscle and fat around the hip that can act as a cushion when they hit the ground.   Laboratory studies have also shown that in the setting of osteoporosis, it is possible to fracture the hip simply by forcefully contracting the muscles that move the hip.  This happens when the patient suddenly slips and moves to catch themselves, for example.  Frequently the patient will actually say that they slipped, felt severe hip pain, and then fell to the ground.

Once the patient is in the hospital and x-rays reveal a hip fracture, they are admitted to the hospital and an orthopedic surgeon is usually consulted to discuss surgical intervention.  This process brings up the hardest question to answer in the course of hip fracture surgery: SHOULD THE FRACTURE BE FIXED?  For a complete discussion of this topic — please click here.

If the patient and the family decide that surgery is the best course of treatment then the patient needs to be cleared for surgery.  Currently, in the United States, the recommendation is to proceed with surgery with the first 24 to 48 hours once the patient’s other medical issues have been addressed.  Practically, this means that the patient needs to be evaluated by an internist or hospitalist (an in-patient physician who works at the hospital),  to make sure that the fall was a simple mechanical fall and did not occur because the patient was having chest pain, an active heart attack, a stroke, or some other medical problem that would take priority over the hip fracture.  Usually a series of lab tests, including an EKG, chest X-ray, complete blood count, urinalysis, and a chemistry profile will be completed.  This workup will usually reveal if the patient also has a pneumonia, urinary tract infection, or unstable heart pain that needs to be treated prior to surgery.  If the patient has a history of atrial fibrillation or has had a cardiac stent placed and they are taking blood thinners, then it is usually necessary to wait several days so that the blood thinners can be eliminated from the system, which will allow the patient’s blood to clot normally during surgery.

Once everyone involved (the hospitalist or medical doctor, orthopedic surgeon, anesthesiologist, patient, and family) all agree that it is time to proceed, the fracture can be safely fixed.

1 comment

  1. peggy t says:

    Thank you for this great website and information! It would have been so nice to have an internet screen available near her ER room (we were there a long time), or in her room upstairs, so I could pull up this website and learn all about this. It also would have made me feel like I was doing something constructive for her. When we run to the ER for an emergency, we don’t usually remember to bring our laptops and we don’t all have smart phones. Even if one does have a smart phone, this is a lot of information to read and think about. An internet screen in the room would be great. Or a loaner Ipad, perhaps.
    Just a thought. And thanks again for doing this.

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