Hip fracture

Take immediate action

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 hip 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 bone for 20 minutes at a time, at two-hour intervals.
   

What is a fracture?

In dealing with your child’s hip fracture, you may want to know the basics about what fractures are, how fractures in a child differ from fractures in adults, and what’s unique about hip fractures.

Fractures happen when there’s more force applied to the bone than the bone can absorb. If your child has a fracture, it means that his bone has partially or completely broken.

• 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.

Note: If your child has an open (compound) fracture (the bone is visible through the skin), it’s an emergency. Call 911 immediately.
 

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.
   

Your child’s hip joint

The hip joint is one of the body's most reliable structures, providing movement and support without pain or problems in most people for a lifetime. The hip's simple ball-and-socket arrangement—with the ball-shaped head of the thigh bone rotating inside a cup-shaped socket called the acetabulum—usually works well with amazingly little friction and little or no wear.

The well-fitting surfaces of the head of the thigh bone and the acetabulum, which face each other, are lined with a layer of cartilage, lubricated by a thin film of fluid. Friction inside a normal hip is less than one-tenth that of ice gliding on ice.
 

What is a hip fracture?

A hip fracture is a partial or complete break in any of the three bones of the pelvis that make up the hip: the illium (upper part), the ischium (lower part) or the central pubis that joins the ischium on either side. Fractures can also occur where the thigh bone (femur) angles into the hip socket, or in the socket (acetabulum) where the thigh bone rotates.
 

What are kids’ risk factors for kids breaking the hip?

A child’s 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)
   

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)

FAQ

Q: What is a fracture? What is a “broken hip?”
A: A fracture is a partial or complete break in a bone. A hip fracture is a partial or complete break in any of the three bones of the pelvis that make up the hip: the illium (upper part), the ischium (lower part) or the central pubis that joins the ischium on either side. Fractures can also occur where the thigh bone (femur) angles into the hip socket (proximal femur fracture), or in the socket (acetabulum) where the thigh bone rotates.
 

Q: If my child has a broken hip, will he be OK?
A: The overwhelming majority of children treated for a broken hip at 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.
 

Q: How does Children’s treat a broken hip?
A: Your child’s doctor may recommend some combination of these treatments:

• rest and ice packs: reduce swelling, redness and pain
• medication to:
  • control pain
  • reduce painful muscle spasms
  • prevent infection if the fracture is open
• pelvic cast or sling: immobilizes the injured area to promote bone alignment and healing, while also protecting the area from motion or impact
• surgery: usually needed to put broken hip bones back into place
  • surgeon may insert metal screws or pins located inside the bone (internal fixation) or outside the body (external fixation) to hold bone fragments in place to allow realignment and healing
• physical therapy: may be needed to strengthen the injured area and help it return to full function
   

Q: What are the signs and symptoms of a broken hip?
A: 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)
   

Q: If my child has a broken hip, what should I ask my doctor?
A: Some of the questions you may want to ask include:

• 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 blood vessels or nerves?
• 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?
   

Q: How is a broken hip usually diagnosed?
A: Testing for a hip fracture—as well as damage to blood vessels, nerves or muscles—can include:

• x-ray—usually sufficient for the majority of fractures
• MRI (magnetic resonance imaging)
• computed tomography scan (CT, CAT scan)
• bone scan
   

Q: What is Children’s experience treating broken bones?
A: At Children’s, we’re known for our clinical innovations, breakthrough research and leadership in orthopedics. We offer the most advanced diagnostics and treatments—several of which were pioneered and developed by Children’s researchers and clinicians.

At our Orthopedic Center or another orthopedic clinical care area (see next question), your child will be seen by an expert team of orthopedic specialists, led by 28 fellowship-trained, board-certified pediatric orthopedic surgeons.
 

Q: What areas at Children’s treat fractures?
A: At Children’s, several of our orthopedic clinical care areas treat fractures. These include our:

• Child and Adult Hip Preservation Program
• Hand and Upper Orthopedic Extremity Program
• General Orthopedic Program
• Lower Extremity Program
• Sports Medicine Division
• Orthopedic Trauma Program

Causes

Whether it’s falling off a bike or colliding in sports—active kids can find many ways to break their bones. A hip break is a serious fracture, which usually occurs only if the bone is impacted with tremendous force. Common ways a child could break his hip include:

• trauma, as from a car crash, accident, physical abuse or contact sports injury
• falling from a steep height

Signs and symptoms

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)

When to seek medical advice

A hip fracture should be treated quickly and correctly—the hip is the body’s connection to the legs and is crucial for movement. Consult your pediatrician immediately if your child has:

• 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)

Questions to ask your doctor

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:

• 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?

Who's at risk?

A child’s risk for developing a fracture increases if he has:

• a 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)
   

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

Complications

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.
• post-surgery complications, including:
  • infection
  • damage to blood vessels or nerves

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 Children’s have corrections that enable their bones to grow normally—so they can walk, play, grow and live active lives.

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 Children’s Orthopedic Center is always here for you, too.

Prevention

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:

• 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.
• Make sure he eats 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.

Glossary

• bone remodeling: 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.
• bone scan: a non-invasive imaging technique that uses a radioactive substance 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.
• The Center for Families at Children’s: gateway to services and amenities at Children’s; dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care
• cartilage: smooth, rubbery tissue that cushion the bones at the knee joint, between the vertebrae and other areas; allows the bones to move easily without pain
• cast/sling: external devices used to immobilize and hold a broken hip in place while it heals
• computed tomography (CT, CAT) scan: a non-invasive procedure that uses X-ray equipment and powerful computers to create detailed, cross-sectional images of your child’s body. The CT scanner is a large machine that looks like a big doughnut.
• diagnosis, diagnostics: identifying disease or injury through examination, testing and observation
• femur: thigh bone (upper leg); the longest and strongest of your child’s bones; one of the three long bones in the leg
• fracture: a partial or complete break in the bone
• growth disturbance: 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 limbs in children must account for these growth plates.
• growth plate (physis): areas of cartilage at either end of a bone from which growth occurs. As key components of a child’s developing skeletal system, growth plates largely turns to bone (ossify) as a child grows.
• internal fixation: metal screws and pins surgically inserted inside the bone to hold bone fragments in place to allow alignment and healing
• mal-union (mal-alignment): a condition in which a broken bone heals in a poor alignment or a deformed state (such as an angular deformity); rare in children
• MRI (magnetic resonance imaging): produces detailed images of organs and structures within the body; best for looking at soft/non-bone tissues such as ligaments, tendons, muscle, and cartilage.
• non-surgical (non-operative) treatments: alternatives to surgery
• open reduction: Using screws and pins, the doctor realigns and affixes the bone fragments (internal fixation) through an incision, then holds them in place with an external cast or sling during the healing period.
• orthopedic surgeon, orthopedist: a physician specializing in surgical and non-surgical treatment of the spine, skeletal system and associated muscles, joins and ligaments
• orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
• physeal fracture: a break that occurs at, into or across a growth plate; must be treated promptly to avoid growth disturbance or deformity
• physical therapy: a rehabilitative health specialty that uses therapeutic exercises and equipment to help patients improve or regain muscle strength, mobility and other physical capabilities
• physis, physes: growth plate(s) at both ends of a bone; the source of bone growth
• post-operative (post-op): after surgery
• pre-operative (pre-op): before surgery
• skeletally immature: in pre-pubescent or early-adolescent children, the bones of the skeleton haven’t yet fully grown
• traction: a sustained mechanical pull to correct a broken or dislocated bone; requires a prolonged hospital stay, and is often less effective than current surgical techniques; used infrequently for kids’ fractures at Children’s, mostly to temporarily position the bone (often a femur) while the child awaits surgical repair
• x-ray (radiograph): common, diagnostic radiology; shows the dense structures, including bones, inside your child’s body. X-rays are fast, non-invasive and easy to take, making them particularly useful for emergency diagnoses.