Hip fracture in the elderly

Fractures in and around the neck of the thigh bone that forms the lower part of the hip joint are called hip fractures. These fractures constitute a significant problem especially for the elderly.

While hip fractures may occur rarely and only with high-energy trauma such as a traffic accident in young people, a simple fall may be sufficient cause for fracture in the elderly. Osteoporosis (bone loss) has an important role in the formation of fractures as a result of simple falls.

Osteoporosis is more common especially in postmenopausal women, and therefore hip fractures are more common in women in advanced age. The bone of poor quality can easily break for a simple reason such as the person’s foot tripping over something at home. Sometimes, without falling, it is possible for the weakened bone to spontaneously fracture gradually.


Most common causes of hip fractures

Blood pressure irregularity, which is often seen with advanced age.

· Occurrence of visual impairment.

Weakening in reflexes and muscle strength.

While an elderly person falling to the ground while standing generates much more than enough energy for a hip fracture, less than two percent of falls result in a hip fracture.


The patient is unable to walk and there is severe pain in the hip area that increases with movement. The leg on the broken side is shortened and turned outward. X-rays are often sufficient for diagnosis. However, x-rays may not be sufficient in some fractures that have not displaced. In these cases, advanced diagnostic methods such as computed tomography and magnetic resonance imaging are additionally applied. Hip fracture should be suspected in elderly patients who complain of pain in the hip and inability to walk after a fall, and the patient should be taken to the hospital by ambulance in a short time without pressing on them.


The aim in the treatment of hip fracture is to save the patient from bed dependence as soon as possible and to enable him to walk as before. What options are there in surgical treatment?

SURGERY: In surgical treatment, one of two different options is decided. The first of these are surgeries that aim to bring the broken pieces together and weld them together. These surgeries, called “osteosynthesis”, can be performed at any age in fractures of the lower region of the femoral neck (trochanteric region) with a high potential for fracture union, and in neck fractures in patients who are not very old and have an active life expectancy and are brought to the hospital without delay. In these surgeries, special nail, plate or screw systems manufactured for hip fractures are used to fix the fracture. During the union, the patient walks without giving full weight to that side.

PROSTHESIS: If the condition of the patient and the fracture allows, osteosynthesis surgery is the option to be preferred. The second surgery option is prosthesis. The prosthesis is preferred especially in displaced fractures of the femur neck, which is known to have a low potential for fracture union, and in very elderly patients. In these surgeries, the femoral head above the fracture is removed and a metal prosthesis is placed in its place. After this surgery, it is possible for the patient to walk immediately with full weight bearing.

What happens if the operation is not performed?

The organ systems and mental state, which are difficult to balance in the elderly, are completely deteriorated with hip fracture. Metabolic balances are upset. Pre-existing diseases such as diabetes, heart disease, lung disease are getting worse. Since the fracture causes a lot of pain even with small movements, meeting the need for the toilet and ensuring cleanliness creates serious difficulties for both the patient and the caregiver. Pressure sores can occur in places that come into contact with the bed.

Even if the patient can be kept alive for months with care and supportive treatment without surgery, most hip fractures do not heal spontaneously. This will leave a serious disability that prevents walking. All these problems can only be overcome by operating the patient and getting him up and running as soon as possible.

What are the risks of the surgery?

Elderly people who have had a hip fracture have a very high 20 percent chance of losing their lives in the first three months, despite being operated on. The most important factor here is the patient’s pre-existing systemic health problems. In addition, problems such as inflammation in the surgical field, obstruction caused by the blood clot accumulating in the leg veins, and the spread of this clot to the lungs or brain may be encountered.

In order to reduce the risks, a series of examinations and systemic examinations are performed on the patients before the operation. Physicians of the relevant branches evaluate the patient together and the necessary treatments are started to be applied. The situation is explained in detail to the patients and their relatives. Risks can be minimized by making the pre-operative preparations completely and quickly, performing the surgery successfully, taking necessary precautions by anticipating possible medical problems, quality post-operative care and appropriate treatment.

How can we avoid hip fracture?

Major ways to prevent osteoporosis; not gaining weight, doing regular exercise and walking according to age, regularly going out to the sun and getting enough calcium with food.

Bone density measurement, especially in menopausal women, helps to obtain more concrete information about bone quality.

· Some arrangements can be made regarding life to reduce the risk of falling. These measures include removing carpet pieces, door sills and connecting cables from the walking area, fixing carpets, placing non-slip floor coverings on slippery floors such as bathrooms, placing handles in bathrooms and toilets, and adequate lighting of the living area.

· It may be recommended that elderly people who live alone carry a mobile phone with them or hang a whistle around their necks even when they go to the toilet so that they can notify themselves when they need help.

Using a cane not only reduces the load on the joints, but also contributes to balance. Deciding not to leave the house in order not to fall is the biggest mistake. On the contrary, it will be more correct to stay healthy, provided that it is safe, walking at reasonable distances and in the sun every day.

It should not be forgotten that preventing hip fracture is much easier and more advantageous in every respect than treating the fracture.

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