Hip Fracture | Diagnosis & Treatments

How do you diagnose a broken hip?

At Boston Children’s Hospital, we know that the first step in treating your child’s broken hip is to form an accurate and complete diagnosis.

During a physical exam, the doctor obtains a complete medical history of your child and asks how your child got hurt. The physician will look for any injuries commonly associated with hip fractures. These can include injury to any of the structures housed by the pelvic bones, such as the lower portion of the intestines and rectum, the urinary bladder, and the reproductive organs. Other commonly associated injuries include head injuries and additional fractures.

The doctor will examine any lacerations to determine whether an open fracture (bone visible through the skin) has occurred, and will press on front and back of the pelvic area to help determine how stable the hip is. A rectal examination also may be performed to look for hemorrhage that may signify bone penetration into the rectum.

Diagnostic testing for a broken hip

  • x-ray: uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film — usually sufficient for the majority of fractures
  • MRI (Magnetic Resonance Imaging): uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body; especially useful for assessing soft tissue around injured joints and bones
  • computed tomography scan (CT, CAT scan): uses a combination of x-rays and computer technology to produce 3-D cross-sectional images (slices), both horizontally and vertically, of the affected area — including bones, fat, and soft tissue
  • bone scan: uses a radioactive dye to visualize the bones. It’s different from plain x-rays or CT in that it shows bone metabolism and cell activity in the bones. Bone scans are used to assess bone growth activity, bone remodeling activity, and/or blood flow in the affected area(s).

Treating a hip fracture

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

If you think your child has broken his hip, you should take him to the Emergency Room. If you’re waiting to see your child’s doctor, it may help to use self-care first aid remedies to reduce swelling and pain:

  • rest: Make sure he doesn’t exert his leg without support; he can use crutches or a cane, if it helps.
  • ice: Wrap a towel around ice cubes, an ice pack, or a frozen food package to ice the leg for 20 minutes at a time, at two-hour intervals.

How Boston Children’s treats a broken hip

Boston Children’s Hospital’s hip sub-specialists provide comprehensive treatment — including evaluation, diagnosis, consultation, and follow-up care — to their young patients. How we’ll treat your child’s hip fracture depends on the location, complexity, and severity of his break — as well as his age and overall health. Boston Children’s orthopedic experts in the Child and Young Adult Hip Preservation Program will provide comprehensive treatment — including evaluation, diagnosis, consultation, and follow-up care.

The overwhelming majority of children treated for a broken hip at Boston Children’s have corrections that enable their bones to grow normally — so they can walk, play, grow, and live active lives. Kids’ bones heal quickly, and usually without complications.

Our treatment goals are to:

  • control your child’s pain
  • promote healing
  • prevent complications
  • restore normal use of the fractured area

To restore your child’s use of his broken hip bone, his doctor may recommend some combination of these possible treatments:

  • rest and ice packs to reduce swelling, redness, and pain
  • medication
  • surgery: usually needed to put broken hip bone(s) back into place
    • in open reduction, the surgeon inserts metal screws and pins (internal fixation) to hold bone fragments in place to allow alignment and healing
  • pelvic cast or sling: immobilizes the injured area to promote bone alignment and healing, while also protecting the injured area from motion or impact; at Boston Children’s, our experts fit your child for his cast or sling
  • physical therapy: may be needed to strengthen your child’s muscles and help his hip return to full function


Other 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. Other commonly associated injuries include head injuries and additional fractures.

Complications after treatment

Most non-surgical and surgical corrections of childhood fractures occur without complications. Although complications are relatively uncommon, they can occur and can include:

  • Osteonecrosis (avascular necrosis): Bone death caused by lack of blood supply to the bone. A hip fracture can happen close to the network of blood vessels that go to the head of the femur.
  • Growth disturbances: A fracture that extends into the bone’s growth plates in still-growing children can disturb or stop the normal growth of the bone (growth arrest). This can lead to limb length discrepancies or angular deformities. Surgery on broken bones in children must account for these growth plates.

Long-term outlook

Our research into bone problems means that we can provide your child with the most innovative care available. As a result, the overwhelming majority of children treated for hip fractures at Boston Children’s have corrections that enable their bones to grow normally — so they can walk, play, grow, and live active lives.

Care after surgery

Tips if you or your young child is in a cast

  • Keep your child’s cast clean and dry.
  • Check for cracks or breaks in the cast.
  • Put pads on rough edges to protect the skin from scratches.
  • Don’t scratch the skin under the cast by inserting objects inside the cast.
  • Use a hairdryer placed on a cool setting to blow air under the cast and cool down the hot, itchy skin. Never blow warm or hot air into the cast.
  • Cover the cast while your child is eating to prevent food spills and crumbs from entering the cast.
  • Prevent small toys or objects from being put inside the cast.
  • Elevate the cast to decrease swelling.
  • Encourage your child to move his toes to promote circulation.

Healing time after treatment

A hip fracture is a serious injury, and it usually means that your child will need surgery. There may be exceptions, but as a general guideline, the younger the child, the quicker he’ll heal.

  • Children and teens typically need to be in a cast for four to six weeks after surgery.
  • Infants, toddlers, and very young children who are treated non-surgically with a hip spica cast (a cast that >includes the trunk of the body and one or more limbs) often need less time to heal.

Coping and support

If your child or teen is being treated for a broken hip, the best thing you can do for him is to keep and model a positive attitude. Make a game out of keeping your small child’s cast dry during bathing. Start a countdown calendar for your teen to help him see progress toward getting back to normal — and toward getting back into his game if he plays sports.

Still, we understand that a hospital visit can be difficult. So, we offer many amenities to make your child’s — and your own — hospital experience as pleasant as possible. Visit the Hale Family Center for Families for all you need to know about:

In particular, we understand that you may have a lot of questions when your child is diagnosed with a hip fracture. Will my child need surgery? How long will his recovery take? Will it affect my child long term? What should we do at home? We can help you connect with extensive resources to help you and your family through this stressful time, including:

  • patient education: From doctor’s appointments to treatment to recovery, our nurses and physical therapists will be on hand to walk you through your child’s diagnosis, treatment, and recovery. And once your child is home, we’ll help you coordinate and continue the care and support he received at Boston Children’s.
  • parent-to-parent: Want to talk with someone whose child has been treated for hip dysplasia? We can often put you in touch with other families who’ve been through the same experience that you and your child are facing.
  • faith-based support: If you’re in need of spiritual support, we’ll connect you with the Boston Children’s chaplaincy. Our program is a source of spiritual support for parents and family members. It includes nearly a dozen clergy members — representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian, and United Church of Christ traditions — who will listen to you, pray with you, and help you observe your own faith practices during your child’s treatment.
  • social work: Our Social Work and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to coping with illness, and dealing with financial issues.