Hip Fractures

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Hip fracture is one of the most common musculoskeletal injuries, causing significant morbidity among older people in Singapore. Hip fractures are a significant health concern; patients with a fractured hip have reduced mobility, independence, and quality of life.

What are Hip Fractures?

A hip fracture refers to a break in the upper portion of the femur (thigh bone) within or near the hip joint. The severity and specific location of the fracture can vary, but it typically occurs in one of three areas: the femoral neck, intertrochanteric region, or subtrochanteric region. These fractures are often categorised based on their location:

Femoral Neck Fractures: Occur just below the ball (femoral head) of the hip joint. These fractures are often intracapsular, meaning they occur within the hip joint capsule.
Intertrochanteric Fractures: Occur between the neck of the femur and the long shaft of the bone.
Subtrochanteric Fractures: Occur below the intertrochanteric region, in the femur shaft.

What are the Common Causes and Risk Factors of Hip Fracture?

Most cases of hip fractures in Singapore are caused by trauma, with falls being the most common cause, especially among the elderly. Apart from falls, other factors which may increase the risk of hip fractures include:

Osteoporosis: Individuals who are diagnosed with osteoporosis, a condition characterised by brittle bones, are more prone to hip fractures.
Ageing: Bone density decreases with age. Similarly, muscle strength and balance may also decline with increasing age, making falls more likely.
Gender: Women are more prone to hip fractures than men, largely due to the higher prevalence of osteoporosis.
Medications: Certain medications can affect bone density or balance, increasing the risk of falls. Research has shown that individuals consuming heparin, warfarin, cyclosporine, glucocorticoids, medroxyprogesterone acetate, some cancer drugs, and thyroid hormones will experience losses in bone density.
Nutritional Deficiencies: Deficiencies in calcium and vitamin D can weaken bones, resulting in brittle bones that are more prone to fractures.
Physical Inactivity: Sedentary lifestyles can lead to weaker muscles and bones.

What are the Symptoms of Hip Fracture?

Pain: Moderate to severe pain in the hip or groin area
Weight-bearing: Inability to bear weight on the leg at the side of the broken hip.
Bruising: Bruising may spread from the hip to the upper thigh area over time.
Limited Range of Motion: Difficulty moving the affected leg.

How are Hip Fractures Diagnosed?

Orthopaedic specialists often begin the diagnostic process of hip fractures by taking the patient’s medical history, performing physical examinations, and checking for signs of swelling, bruising, as well as abnormal leg positioning.

If all physical signs point to a potential fractured hip, imaging tests such as X-rays are often recommended to confirm the diagnosis and the site of the fracture. In cases where X-ray radiography is insufficient, additional scans such as CT or MRI scans may be recommended to check if additional injuries to the surrounding tissues are present.

How Serious is a Hip Fracture?

Hip fractures are considered severe injuries, particularly in older adults. If left untreated, necrosis of the displaced bone (part of the bone tissue dies due to a lack of blood flow) may also occur; or nonunion in displaced hip fractures will cause further immobilisation. These conditions will lead to prolonged immobilisation, which in turn may cause further complications, such as pneumonia, pressure ulcers, urinary tract infections and abnormal blood clots in the calf/leg.

What are the Treatment Options for Hip Fractures in Singapore?

In most cases, surgery is the recommended treatment for most hip fractures. Since most patients with hip fractures are over 65 years old with various other pre-existing conditions, presurgical optimisation is also required to ensure that the patient is fit enough to undergo anaesthesia.

In Singapore, there are two common surgical procedures to treat hip fractures, which are determined based on the location of the fracture and the severity of the bone displacement:

Internal Fixation: For neck of femur fracture (intra-articular hip fracture) with no bone displacement, the two fracture bone fragments can be held together using either of these two options: 1) using three cancellous screws to stabilise and compress the fracture; 2) using a titanium plate with screws. The surgical scar for internal fixation is small and heals within two to three weeks.
Hip Replacement (Arthroplasty): For neck of femur fracture (intra-articular hip fracture) with bone displacement, the damaged part of the hip is replaced with an artificial implant. This can be a partial hip replacement or a total hip replacement. Arthroplasty is the preferred treatment for patients over 65 years old with femoral neck fractures that are displaced and have low-energy or fragility type of fracture.

At Alps Orthopaedic Centre, our orthopaedic surgeon is an expert in total hip replacement techniques, such as Enhanced Recovery (ERAS) Direct Anterior Approach Total Hip Replacement, which facilitates faster recovery.

Intramedullary Nailing: The implantation of a titanium rod into the femur bone to stabilise the fracture. This is routinely performed through small incisions, via a minimally invasive technique (MIS surgery).

Alps’ experienced Orthopaedic Surgeon, Dr Jerry Chen, will recommend a suitable treatment option tailored to your unique condition.

It is important to note that timing is an important factor in surgery for patients with hip fractures. Patients who have undergone surgical treatment within 48 hours of fracture are more likely to have an earlier return to mobilisation with better surgical outcomes.

Summary

Hip fractures are a serious condition that can have a profound impact on an individual’s life, particularly among older individuals. Understanding the symptoms, treatment options, and recovery process is crucial for effective management and rehabilitation. With appropriate medical care, surgical fixation and physical therapy, many individuals can recover and regain their independence after a hip fracture injury.

Visit Alps Orthopaedic Centre

If you exhibit early symptoms of hip fractures, book an appointment with our experienced Consultant Orthopaedic Surgeon, Dr Jerry Chen, for a thorough assessment and personalised treatment plan. Dr Chen is an expert in treating all types of hip fractures, including those due to sports injuries.

Frequently Asked Questions

What can I do to Prevent Hip Fractures?

Given the seriousness of hip fractures, prevention strategies are crucial. These include implementing measures to prevent falls, such as home safety modifications, using assistive devices, and engaging in balance and strength training exercises. Maintaining good bone health through adequate consumption of calcium and vitamin D, weight training, and managing conditions like osteoporosis also reduces the risks of hip fractures.

Can Hip Fractures Recur Post-Surgical Intervention?

Secondary Fractures: Individuals who have sustained a hip fracture are at higher risk of subsequent fractures, particularly if underlying conditions like osteoporosis are not adequately managed.

References

Gatot C, Tan ESE, Liow MHL, Chen JY et al. Higher Charlson Comorbidity Index Increases 90-Day Readmission Rate with Poorer Functional Outcomes in Surgically Treated Hip Fracture Patients. Geriatr Orthop Surg Rehabil. 2021 Aug 13;12:21514593211036252. doi:10.1177/21514593211036252
LeBLANC KE, Herbert L. Muncie J, LeBLANC LL. Hip Fracture: Diagnosis, Treatment, and Secondary Prevention. afp. 2014;89(12):945-951.
Bhandari M, Swiontkowski M. Management of Acute Hip Fracture. Solomon CG, ed. N Engl J Med. 2017;377(21):2053-2062. doi:10.1056/NEJMcp1611090
Kazley J, Bagchi K. Femoral Neck Fractures. In: StatPearls. StatPearls Publishing; 2024. Accessed May 12, 2024. http://www.ncbi.nlm.nih.gov/books/NBK537347/
Almejrad FA, Alotaibi AFS, Albarakati MA, et al. An overview of hip fracture evaluation & management approach: literature review. Pharmacophore. 2020;11(2):118-122.
Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: A review. World Journal of Orthopedics. 2014;5(4):402-411. doi:10.5312/wjo.v5.i4.402
Beer C. Hip fracture: Challenges in prevention and management. Australian Family Physician. 2005;34(8).
8. Kim DC, Honeycutt MW, Riehl JT. Hip fractures: current review of treatment and management. Current Orthopaedic Practice. 2019;30(4):385-394. doi:10.1097/BCO.0000000000000771

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Dr Jerry Chen

MBBS (S’pore), MRCSEd, MMed (Ortho), FRCSEd (Ortho)

Fellowship-trained Consultant Orthopaedic Surgeon & Medical Director

Before starting Alps Orthopaedic Centre, Dr Jerry Chen was a Consultant at Singapore General Hospital (SGH), where he accumulated over 13 years of experience in Orthopaedic Surgery.
Dr Chen spearheaded the workgroup for Enhanced Recovery After Surgery (ERAS) for hip and knee replacement surgeries at SGH, where he successfully employed ERAS, benefiting more than 2,000 patients thus far.
Having performed over 500 surgeries in a year, he has been instrumental in helping numerous patients recover from injuries and diseases and return to their active lifestyles.
His clinical interests include Enhanced Recovery After Surgery (ERAS) for Hip and Knee, Sports Injuries, Minimally Invasive Surgery and Robotic Surgery.

Why Alps Orthopaedic Centre?

At Alps Orthopaedic Centre, we specialise in Enhanced Recovery After Surgery (ERAS). Performed as a Day Surgery, the ERAS Direct Anterior Approach in Total Hip Replacement (THR) technique as well as ERAS Total Knee Replacement (TKR), reduces the average hospitalisation stay, utilising techniques which enable the patient to suffer from less pain and recover faster. We are an Orthopaedic clinic in Singapore, which specialises in ERAS and do our utmost to enable patients to return to everyday activities as early as possible.

Our Orthopaedic clinic provides specialised diagnosis and effective treatment of musculoskeletal problems, especially Day Surgery / Enhanced Recovery After Surgery (ERAS) For Hip and Knee Surgery, Sports Injuries and Trauma Fractures. If you are considering hip or knee surgery or minimally invasive treatments, book an appointment with our experienced Consultant Orthopaedic Surgeon, Dr Jerry Chen, for a thorough assessment and treatment plan.

Our aim is to boost patient well-being, optimising every aspect of the surgical journey. By minimising the recovery period, patients are able to go back to activities that they love. The Alps team offers comprehensive financial counselling sessions to ensure our patients understand their options and make informed decisions regarding their treatment plans.

Has this article been insightful? Share it!

Dr Jerry Chen

MBBS (S’pore), MRCSEd, MMed (Ortho), FRCSEd (Ortho)

Fellowship-trained Consultant Orthopaedic Surgeon & Medical Director

Before starting Alps Orthopaedic Centre, Dr Jerry Chen was a Consultant at Singapore General Hospital (SGH), where he accumulated over 13 years of experience in Orthopaedic Surgery.
Dr Chen spearheaded the workgroup for Enhanced Recovery After Surgery (ERAS) for hip and knee replacement surgeries at SGH, where he successfully employed ERAS, benefiting more than 2,000 patients thus far.
Having performed over 500 surgeries in a year, he has been instrumental in helping numerous patients recover from injuries and diseases and return to their active lifestyles.
His clinical interests include Enhanced Recovery After Surgery (ERAS) for Hip and Knee, Sports Injuries, Minimally Invasive Surgery and Robotic Surgery.

Why Alps Orthopaedic Centre?

Has this article been insightful? Share it!

Dr Jerry Chen

MBBS (S’pore), MRCSEd, MMed (Ortho), FRCSEd (Ortho)

Fellowship-trained Consultant Orthopaedic Surgeon & Medical Director

Before starting Alps Orthopaedic Centre, Dr Jerry Chen was a Consultant at Singapore General Hospital (SGH), where he accumulated over 13 years of experience in Orthopaedic Surgery.
Having performed over 500 surgeries in a year, he has been instrumental in helping numerous patients recover from injuries and diseases of the musculoskeletal system.
As a driven and valued member, Dr Chen spearheaded the workgroup for Enhanced Recovery After Surgery (ERAS) for hip and knee replacement surgeries at SGH.
Over the course of his career at SGH, Dr Chen has successfully employed ERAS and reduced the average hospitalisation stay for hip and knee replacement surgeries.
Going through these ERAS day surgeries has benefited more than 2,000 patients thus far, enabling them to suffer from less pain and recover faster.
The Alps team is committed to providing specialised orthopaedic care tailored to your unique condition. We offer comprehensive financial counselling sessions to ensure our patients understand their options and make informed decisions regarding their treatment plans.