Fractures of the hip and pelvis

Anatomy: Understanding the hips and pelvis

The hip forms the joint between the thigh bone (femur) and the hip socket (acetabulum) in the pelvis. The pelvis consists of the ilium, ischium and pubic bone and is connected by ligaments to form a stable pelvic ring. Strong muscles and tendons as well as tight ligaments provide stability, while cartilage and labrum (joint lip) distribute the load and improve joint control.

• Femoral head and femoral neck: transition from the thigh to the joint
• Trochanteric region: bony projections for muscle attachments
• Hip socket (acetabulum): joint socket in the pelvis
• Pelvic ring: Anterior and posterior ring with strong ligament structures

What are fractures of the hip and pelvis?

Fractures are bone breaks caused by external force or poor bone quality (e.g. osteoporosis). In the hip-pelvic area they often affect the femoral neck, the trochanter region or the hip socket; In the pelvis, parts of the anterior ring (pubic bone, ischium) or the posterior ring with the sacroiliac joint can be involved. Stability, displacement and accompanying injuries determine the treatment.

Causes and risk factors

• Falling on your side or from a height (common in older people)
• High energy trauma: traffic accident, sports collision, fall from a height
• Osteoporosis or bone disease (decreased bone density)
• Previous hip diseases, implants, long-term cortisone therapy
• Coordination disorders, poor eyesight, unsteady gait
• Environmental factors: slippery floors, lack of aids

Types of hip and pelvic fractures

The classification helps to assess stability and need for therapy. An exact assignment is made based on imaging.

• Femoral neck fracture: fracture between the femoral head and trochanter region; Risk of circulatory problems in the femoral head.
• Pertrochanteric and subtrochanteric fractures: fractures in the area of ​​the bone protrusions or just below them; mostly displaced by tensile forces.
• Avulsion fractures: Avulsion of small parts of the bone in the pelvis due to sudden muscle tension (especially during sports).
• Hip socket fracture (acetabulum): Fracture of the socket close to the joint; Joint incongruence and cartilage damage possible.
• Pelvic ring fracture: Injuries to the anterior (pubic bone/ischium) and/or posterior ring (sacral area). Can be stable or unstable.
• Fragility fractures of the pelvis (osteoporotic): Low-energy fractures in older people, often with initially non-specific pain.

Symptoms and warning signs

• Sudden severe pain in the hips, groin, buttocks or pelvis
• Inability to bear weight, limping, leg rest position
• Malposition, leg shortening or external rotation
• Swelling, bruising, tenderness
• For pelvic ring injuries: pain when standing up, turning, coughing; sometimes just depending on the load

Emergency information: If there is a visible misalignment, extensive pain after a fall, sensory disturbances in the legs or bladder/intestinal problems, please call the emergency services (112) immediately or go to an emergency room. Don't go alone or carry on the burden.

Diagnostics in our practice in Hamburg

We take a structured anamnesis, check signs of stability and carry out targeted imaging. Patients who appear stable can initially be evaluated on an outpatient basis. If an unstable or extremely painful fracture is suspected, we will coordinate a quick presentation to the clinic.

Therapy: conservative, graduated and individual

Treatment depends on fracture type, stability, displacement, biological age, comorbidities and mobility goals. Conservative measures come first where safely possible. Surgical procedures make sense if stability, joint function or pain control cannot be achieved otherwise. We provide open-ended advice and coordinate necessary steps.

• Conservative (for stable, slightly displaced fractures): relief/partial weight-bearing with forearm crutches, pain therapy, physiotherapy, thrombosis prophylaxis, early sitting and standing mobilization, follow-up checks with imaging.
• Functional treatment for avulsion fractures and stable pelvic ring fractures: protection, targeted strengthening, gradual increase in load.
• Surgical (for unstable, displaced or joint-involving fractures): screw or plate osteosynthesis, dynamic hip screw, intramedullary nail, minimally invasive screw connections, if necessary joint replacement (hemi/total endoprosthesis) for certain femoral neck fractures in older age.
• Perioperative management in the clinic: pain and thrombosis prophylaxis, early mobilization, infection and fall prevention. We accompany the aftercare in the practice.

Specific treatment scenarios (examples)

• Femoral neck fracture: Younger patients often require screw-based stabilization. In older people with a significantly displaced fracture, a prosthetic solution is often used for safe mobilization.
• Pertrochanteric/subtrochanteric fracture: Usually intramedullary nail or dynamic screw plate for stability and early resilience.
• Acetabular fracture: The goal is a congruent articular surface; Depending on the fracture pattern, conservative approach with partial weight-bearing or reconstructive surgery in the clinic.
• Pelvic ring fracture: Stable anterior ring injuries conservatively; Unstable patterns often require minimally invasive screwing of the rear ring.
• Osteoporotic fragility fracture: Pain-adapted mobilization, targeted analgesia, osteoporosis treatment and close follow-up.

Rehabilitation and aftercare

A structured rehabilitation plan supports healing, mobility and independence. The periods are individual and depend on the fracture type, stability and comorbidities.

• Pain management: step-by-step scheme, local measures (cold/warm), protection without immobilization if possible.
• Load build-up: From relief/partial weight-bearing to full weight-bearing according to medical instructions and imaging.
• Physiotherapy: gait training, muscle strengthening, mobility, balance training, later functional training.
• Aids: forearm crutches, walking trestle, seat wedges, raised toilet seat, non-slip shoes.
• Thrombosis prophylaxis: exercise, compression, if necessary medication as directed by a doctor.
• Check wounds and scars after surgery, pay attention to signs of infection.
• Return to everyday life and work: gradually, taking activity profile into account; If necessary, rehabilitation regulations.

Bone health and osteoporosis management

After fragility fractures, the diagnosis and treatment of osteoporosis is crucial in order to prevent further fractures. We advise on lifestyle, supplements and – if indicated – drug therapy in coordination with family doctors and specialist colleagues.

• Calcium and vitamin D optimization (diet, supplements as needed).
• Strength, balance and coordination training to prevent falls.
• Drug therapy for osteoporosis according to diagnosis and guideline indication.
• Checking fall risks in the living environment (lighting, carpet edges, grab handles).

Prevention: Avoid falls, strengthen bones

• Regular training: leg and core strength, balance.
• Update visual aids, wear appropriate shoes.
• Secure the living environment: remove tripping hazards, grab bars in the bathroom, good lighting.
• Adequate protein intake and a bone-healthy diet.
• Medication check (e.g. sedatives) with the family doctor.

Possible complications (rare but relevant)

• Thrombosis/embolism, infections
• Non-union (pseudarthrosis), delayed healing
• Joint stiffness, muscle weakness, pain
• Femoral head necrosis after femoral neck fracture
• Leg length discrepancy, implant failure
• Chronic symptoms caused by cartilage damage (e.g. after a socket fracture)

Structured follow-up care, exercise and treatment of risk factors reduce the risk. No guarantees can be given.

When to come to us, when to the emergency room?

• Immediate emergency room/emergency service (112): severe pain after a fall, visible misalignment, inability to get up, sensory or circulatory disorders, bladder/intestinal problems.
• Appointment in our practice: persistent groin/pelvic pain after a fall without clear misalignment, pain under strain, clarification of unclear findings, aftercare and rehabilitation planning.

Our practice address: Dorotheenstraße 48, 22301 Hamburg. We work with trauma surgery clinics in Hamburg when inpatient care is required.

Course and prognosis

The healing time varies: More stable fractures often heal in weeks to a few months, while complex fractures or fractures involving a joint take longer. Appropriate therapy, pain-adapted mobilization, good physiotherapy and the treatment of concomitant illnesses are crucial. An exact prediction is not possible; The progress is monitored individually and the procedure is adjusted if necessary.