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Overview

A hip fracture is a more complicated medical problem than many people realize. Yes, it’s a broken bone in the hip joint, but geriatric (or osteoporotic) hip fracture is frequently the harbinger of a host of serious and often life-threatening issues among the elderly. 

And the far-less-common type of hip fracture that tends to affect young people, usually caused by a high-impact trauma, typically comes with multiple other broken bones and injuries. Fortunately, Yale Medicine's Orthopedics & Rehabilitation excels at treating both categories of hip fractures.

What is an osteoporotic hip fracture?

The root cause of the vast majority of hip fractures is low bone density, usually related to aging (although it can also be a result of other medical conditions, such as an eating disorder). According to Michael Baumgaertner, MD, director of Yale Medicine’s Orthopedic Trauma Service, this kind of hip fracture affects the ball (most common) and/or, less frequently, the socket part of the hip joint. 

More than 300,000 people (three-quarters female, as osteoporosis is more common in women) over 65 years old in the United States are hospitalized for a hip fracture each year. Yale New Haven Hospital alone treats between 400 and 500 geriatric hip fractures each year.

How is osteoporotic hip fracture diagnosed and treated?

Most geriatric hip fractures are diagnosed in the emergency room, based on the patient’s description of symptoms (a fall, followed by intense pain in the hip or groin), a physical exam and an X-ray. Treatment involves surgery, either to replace the fractured ball joint or to repair the leg’s femur bone. But, because these injuries are unpredictable, most hospitals struggle to schedule these operations in a streamlined way. Patients may be admitted and given painkillers until their surgeon and an operating room are available. That often takes several days, which is not optimal for these fragile patients.

In response to this challenge, Yale Medicine has pioneered an innovative, streamlined geriatric hip fracture service to provide the optimal care these patients need. Dr. Baumgaertner says: “The average length of stay has historically been far longer than it needed to be. There is good evidence that there are better outcomes when the fracture is treated quickly.”

At Yale Medicine, a person thought to have (or diagnosed with) a geriatric hip fracture goes to Yale New Haven’s Saint Raphael Hospital campus and is admitted to the geriatric hip repair service, specifically designed for patients over 55. A protocol has been established to deliver preoperative care rapidly and efficiently. “The process is standardized, so everything happens quickly and in the right way,” Dr. Baumgaertner says.

The affected area is numbed with a nerve block within two hours to keep the patient pain free without having to use opioid medications, which can bring complications such as delirium. An operating room staffed by an orthopaedic surgeon and support team is available for surgery every morning. “We’ve been able to reduce the time before a patient gets surgery by 12 hours, on average,” Dr. Baumgaertner says.

The multidisciplinary postoperative care is streamlined, standardized and coordinated, too. Most patients spend two to four days in the hospital before being discharged to a skilled nursing center for rehabilitation, to be followed by outpatient physical therapy.

How is the other type of hip fracture, caused by trauma, diagnosed and treated?

Hip fracture due to “high-impact, violent trauma,” such as a fall from a great height or a motor vehicle accident, is handled differently. This type of hip fracture is called a femoral neck fracture; the break is at the top of the femur. Though these patients also require surgery, the procedures tend to be complicated by the fact that there may be many fractured bones and other medical problems that need to be addressed at the same time.

“Because we’re a trauma center, it’s very common for other hospitals to transfer these patients to us immediately for care,” says Dr. Baumgaertner. “We are geared toward these very complex operations.”

Diagnosis and treatment for femoral neck fractures are highly individualized, based on what’s required to give the patient the best hope of a full recovery. Imaging studies and surgical repair, sometimes including multiple procedures, are required. Patients are followed closely and treated with the support services, including physical therapy, necessary to help them get back to their normal lives.

What makes Yale Medicine's approach to treating hip fracture unique?

Yale Medicine is a national leader in developing new and better approaches for treating hip fracture, and is the only hospital in the United States with a dedicated geriatric hip fracture service. The highly efficient treatment protocol, developed by Dr. Baumgaertner and his Yale Medicine and Yale New Haven Hospital colleagues, ensures that vulnerable patients are made comfortable and given the highest quality treatment quickly – offering them higher odds of recovery and a speedier return to their lives.

Dr. Baumgaertner says that this commitment to innovation illustrates the most important difference Yale Medicine offers to patients with hip fracture and, indeed, other conditions. “The physicians here take very seriously our role as a leading academic medical center,” he says. “We are dedicated not just to quality of care but also to the improvement of care. Given the large number of patients we treat, I feel a strong sense of responsibility to be identifying even better practices. We are continually focused on finding new and better ways to handle a problem, such as hip fracture, that is only getting bigger. This goes to the whole mission of what the Yale Medical School is all about, which is supporting the drive for more efficient and better medical care.”