Hip Fracture | Symptoms and Causes

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A hip fracture should be treated quickly and correctly—the hip is the body’s connection to the legs and is crucial for movement.

What are the signs and symptoms of a broken hip?

Common signs and symptoms of a broken hip can include:

•   pain or swelling in the hip or groin
•   an obvious deformity or uneven leg lengths
•   inability to stand or walk
•   limited range of motion in the hip area; outward turning of the leg
•   bruising (may indicate damage to blood vessels)

What are the different types of fractures?

•   A break in a bone usually occurs from trauma, a fall or a direct blow.
•   In a closed fracture, the bone is broken but the skin is still intact.
•   A complete fracture is a fracture involving the entire cross-section of the bone.
•   In an open (compound) fracture, the bone exits and is visible through the skin; or a deep wound exposes the bone 
     through the skin, increasing the risk of infection.

How are kids’ fractures different from those of adults?

•   softer bones: Because children’s bones are softer than those of adults, they tend to absorb force more readily and
    therefore break less easily.
•   quicker healing: A child’s break heals much faster than an adult’s break. And the younger the child, the faster the
    healing. This is good news for recovery, but it also means that your child should get medical and/or surgical attention
    quickly to ensure that it heals in the correct position.
•   growth plates vulnerable: Children have open growth plates (physes)—areas of cartilage from which bone grows—
    at several sites in the pelvis as well as at the head of the thigh bone. In performing surgery on broken bones in
    children, surgeons must consider and account for these growth plates.
•   better bone remodeling capacity: Bone remodeling involves the absorption of bone tissue and the simultaneous
    depositing of new bone; a bone’s continuous self-renewal, self-healing and self-realignment, partially through
    reorientation of the growth plate. In kids’ fractures, the bone’s remodeling capability is usually very good, so poor
    alignment (mal-union) is rare.
•   less residual stiffness: Any stiffness from being in a cast readily dissipates in children, whose tissues are more
    resilient.

Risk factors for breaking the hip

A risk for developing a fracture increases if he has:

•   trauma from a car crash, accident, sports injury, fall or physical abuse
•   low mineral content in his bones
•   a genetic disorder that affects his bone metabolism and muscle mass
•   endocrine dysfunction
•   poor nutrition and/or is overweight
•   a lack of calcium in his diet
•   a previous history of fracture(s)

Hip fractures in teens are commonly due to sports injuries. When a hip is fractured, other structures housed by the pelvic bones can get injured, too. These can include:

•   the lower portion of the intestines and rectum 
•   the urinary bladder and the reproductive organs

Note: Boston Children’s Bone Health Program provides comprehensive evaluations of children and adolescents who have, or are at risk for, low bone density. 

Questions to ask your doctor about a broken hip

If your child is diagnosed with a broken hip, you may feel a bit overwhelmed. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all your concerns are addressed. If your child is older, he may want to ask questions, too.

Some of the questions you may want to ask include:

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   •    What bone or bones in the hip has my child broken?
   •    Are other tests needed to diagnose his fracture?
   •    Is there any damage to his nerves or blood vessels?
   •    What actions might you take after you confirm a diagnosis?
   •    Is this going to affect his growth plate, and his normal growth?
   •    How long will it take for him to heal?
   •    Will he need rehab or physical therapy?
   •    Will there be restrictions on my child’s activities? If so, for how long?
   •    Will there be long-term effects? Pain? Arthritis?
   •    What is the follow-up care plan?

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For teens

If you’re teen with a broken hip, you have a lot to cope with. Besides the typical issues any teenager faces—from social acceptance to body changes and more—you’ll also have to deal with medical appointments and procedures, finding alternative ways to get around, keeping your cast or sling safe, clean and dry, and limiting your activities for a period of time.

If you’re usually active, to be experiencing pain or sitting on the sidelines for a while can be depressing and frustrating. If you feel down, angry or anxious through this important time in your life, speak to your doctor, parent or counselor to get help—they’re all on your team, and they want to help. And remember that Boston Children’s Orthopedic Center is always here for you, too.

Preventing a broken hip

It’s hard to prevent a child from breaking a bone—especially if your child is very active and plays sports. But the value of kids’ participation in sports and play greatly outweighs the risk of breaking a bone.

While you can’t prevent your child from breaking a bone, you can help him minimize his risk with simple, common-sense steps:

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Avoid risky behavior that can result in falls or accidents.

•   See that your child wears proper sports and safety gear, including proper footwear if he is a runner.
•   See that he wears his seat belt in the car.
•   Make sure your baby or toddler is secured in his car seat.

A healthful diet: low in fat, high in protein, nutrients and fiber.

Make sure he has plenty of calcium in his diet (milk, yogurt, cheese, fish, and leafy green vegetables are high-calcium foods)

Monitor his portions to help him control his weight, since obesity puts him at greater risk for breaking a bone.

•   Limit sodas and sugary snacks.
•   Have regular sit-down mealtimes, and limit his between-meal snacking

Encourage him to get lots of weight-bearing physical exercise.

Discourage prolonged time watching TV, playing computer games or other sedentary activities.
•   Encourage your young athlete—especially if he’s a runner—to do some cross-training to decrease the possibility
    of stress fractures

Immediately report any suspicion of physical abuse, or the danger of abuse.

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