Hip Fractures

What are hip fractures?

A hip fracture is a break in 1 or more bones of the hip or pelvis.

Not all hip fractures are the same. There are several places where these bones might break and several types of fractures. In a growing child’s hips and pelvis, the most common place for a fracture is where the muscles attach to bone. In children, the attachment point is not fully formed yet, and so it is a weak point.

If a child moves their legs very suddenly and forcefully — for example, during a fall or while playing sports — the muscles that attach to the hip or pelvic bones can pull away and break the bone (avulsion fracture).

For children, hip and pelvic fractures usually happen during car crashes or falls from snowboarding or bicycling. Any child can get a hip fracture. But very young children rarely do because their hip bones are more flexible.

Most hip fractures in children heal without a problem. Your child will have to give up some of their regular activities for about 6 to 12 weeks. Some children may need surgery to repair a hip fracture.

What are the symptoms of hip fractures?

Signs that your child’s hip may be broken include: 

• Severe pain
• Swelling or bruising 
• Not wanting to put weight on the leg 
• Pain with hip or leg movement 

How are hip fractures diagnosed?

If your child has a mild injury around the hip or pelvis, the pain usually goes away after a few days. If the pain does not go away, your child should see an orthopedist for an exam and probably should have X-rays. 

If your child has severe pain or pain that keeps them from doing their usual activities, your child’s doctor will take X-rays to look for fractures. 

If the doctor does not see a fracture on the X-rays, it may be helpful to have advanced imaging, like an MRI (magnetic resonance imaging) or CT scan, to help understand the reason for your child’s symptoms.  

The doctor will also look for other problems that can cause hip pain such as: 

• Bone or joint infection 
• Legg-Calvé-Perthes disease 
• Slipped capital femoral epiphysis 

Some problems that can cause pain can become serious if they are not found and treated early. 

How are hip fractures treated?  

Some children with hip fractures only need to limit their activities and use crutches while the bones knit back together. Others need a cast or surgery, and sometimes both, to keep the bones from shifting while the break heals. If the bones shift, it can cause lasting damage.  

We typically use a spica cast (PDF) (Russian) (Spanish) (Vietnamese), without surgery, for children younger than age 5 or so. Most children older than age 5 need surgery because this is about the age when they start school and wearing a spica cast is not practical. 

Surgery for Hip Fractures 

If your child’s X-rays show the break is bad or the hip is broken in several places, the doctor will recommend an operation to put the bone back in place.  

During the operation, the doctor puts screws or pins in the bone to keep it in place so it can heal well. Some children need to wear a cast after surgery to keep holding the broken bone in place and protect it as it heals. 

Our doctors do both minimally invasive procedures and open surgeries to treat broken hips.  

Minimally invasive surgery for hip fractures 

In minimally invasive surgery for a hip fracture, the doctor makes small cuts (incisions) on your child’s hip. Then, using X-ray guidance, the doctor puts screws or pins across the break. 

Open surgery for hip fractures 

In open surgery (also called open reduction) for a hip fracture, the doctor makes a larger cut on your child’s hip. This lets the doctor see the bone so they can put it back in place. 

What to expect after surgery 

If your child has surgery for a hip fracture, they will most likely be in the hospital about 1 or 2 days. 

Sometimes, doctors use a spica cast along with surgery. The cast gives your child’s hip extra protection. Your child will wear the cast for about 4 to 6 weeks. If your child needs a cast, their team will give you details on how to care for your child while they are wearing it. 

After the Fracture Heals 

After your child is treated for a hip fracture, their doctor will closely monitor them for at least a year to make sure they are healing well. 

Once the fracture has healed, most children have no further problems. But sometimes a problem does develop due to a fracture. For example, there may be a problem with the hip’s shape and function after a fracture (posttraumatic deformity). Or some bone in the hip may die if it did not get enough blood and nutrients for a while (avascular necrosis).  

This may lead to problems as a child grows, like part of the bone growing less than the rest. Growth problems could lead to differences in the length of the child’s legs or trouble with the thighbone fitting, staying or moving well in the hip socket (hip dysplasia). 

Your child’s team will check for signs of problems like this and also make sure you know what signs to watch for and when to call the doctor.  

The team from Seattle Children’s Child and Young Adult Hip Preservation Program treats problems that might happen after a hip fracture. We focus on helping children and teens keep their natural hip and delay or avoid hip replacement. We also work with young adults in their 20s who are seeking care. For those who do need an artificial hip, we offer this option as well. Learn more.