Physiotherapy for Hip Fractures

Older or Younger?

Hip fractures are most common in the elderly population, and are usually due to falls. Falls can be due to weakness of the bones, for example in an elderly patient with osteoporosis. Hip fractures in younger population are more likely due to car accidents or sports injuries.  It is important to have the broken hip repaired as soon as possible otherwise it increases risk of complications and death.

Signs and Symptoms:

• Suddenly the hip area is extremely painful.
• Pain during walking, or unable to walk at all, usually trying to avoid putting weight on the side with injury.
• Sometimes the leg with the fracture can look turned out and shorter than the leg that isn’t affected.
• Bruises along the hip can be there but it isn’t common because the break isn’t close to the skin.
• Sometimes it can be hard to detect because there is no fall, and patient can just have pain in the knee, buttock, or groin region.
• Pain can be constant and sometimes occur while resting.
• Pressing down on the side of the thigh near the bone causes pain.
• There is increased pain on bringing the leg away from your body.

Risk Factors/Causes:

• Hip fractures in younger people are most likely to happen in athletes who do repetitive movements and put strain on their joint. (Stress fracture)

They can also have increased risk of this fracture because of improper training, footwear, and hard surfaces.

• Hip fractures are usually due to falls in older people. There are multiple reasons for why falls can occur.
  • Vitamin D and calcium helps with building bones. Patients with low calcium or vitamin D are at higher risk of weak bone.
• Patients who have decreased bone mass, and less strong bone, for example, in osteoporosis are more likely to injure their hip after a fall.
• Women are more likely to have hip fracture because they also are more likely to have osteoporosis.
• Patients who have osteoarthritis, or pain in joints are more likely to fall and have hip fractures.
• Among older people, those with heart disease are more likely to have hip fracture. Sometimes having heart disease can cause symptoms like dizziness, or “passing out”. Increases overall fall risk.
• Having multiple medications in the elderly, especially for mental illnesses can cause confusion, and increase risk of falls.

Diagnosis:

• A good physical examination includes checking for how the hip lines up with the spine, feeling around at the area of injury, testing how far the hip can move, and checking the strength of the hip.
• Imaging is necessary to see where the hip is fractured. Usually two x-ray views or MRI/CT can be ordered to see where the injury is. There are different areas of the bone where the fracture can be.
• Labs should be ordered such as CBC, electrolytes, urinalysis, PTT, ABG.This is to determine medical condition of the patient if surgery is considered.
• EKG and chest x-ray to check heart function should be done before surgery.

Prevention:

To prevent fractures as a young athlete

• Change the types of physical activities, and do not do one type of repetitive movement all the time.
• Warm up and cool down are important.
• Wear protective footwear with good cushioning.
• Staying hydrated.

For the elderly:

• It is important to decrease risk of osteoporosis or to manage osteoporosis properly.
  • Supplementation with vitamin D
  • Exercise programs and exercise in general reduces risk of falls because it helps strength and balance.
• Not using medications in the elderly that increase confusion, or managing medications properly.

Treatment:

• Treating the pain of the injury is important, if untreated it can lead to delirium (confusion, incoherent thoughts, speech)in the elderly.
• Most types of hip fractures require surgery so it is important to consult an orthopedic surgeon.
• It is important to treat with antibiotics before surgery. If the wound is more contaminated or you can see the bone secondary antibiotics should be added.
• Surgery should be done within 24 hours, delaying it to 48 hours doubles complication risk.
• Physiotherapy soon after surgery is important because patients who walk sooner avoid ulcers and lung complications.
• Physiotherapy is introduced relatively quickly post operatively. Early phyio will prevent muscle atrophy. Physiotherapy will assist in preventing secondary injury to other body parts via compensating for the existing hip injury.
• Early Physiotherapy improves range of motion, quality of life, and return to baseline function.

Prognosis:

This depends on the age of the patient and type of hip fracture. Athletes that have injury because of repeated motions (stress fracture) are less likely to be able to return to their sport. Elderly patients who have had hip surgery have 14-36% chance of death after one year.

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