Hip Stress Fractures : Symptoms, Diagnosis, and Treatment

A hip stress fracture is a type of injury that occurs when there is repetitive stress on the hip joint, leading to a small crack or fracture in the bone. It commonly affects the upper part of the thigh bone, just below the hip joint, and is a relatively rare type of fracture, accounting for 3-5% of all stress fractures.⁽¹⁾

Hip stress fractures are most commonly associated with overuse of the hip joint, especially in athletes who participate in high-impact activities such as running and jumping. In fact, stress fractures make up approximately 20% of all sports medicine injuries.⁽²⁾

It is important to identify and treat hip stress fractures promptly to prevent further damage. If left untreated, the condition can worsen over time and may lead to more serious fractures, which can be debilitating and require more invasive treatment options.

Treatment for hip stress fractures can help alleviate pain and provide relief to the patient. It can also aid in restoring mobility and enabling a return to normal activity. Additionally, treating hip fractures can address underlying bone weakening conditions, allowing patients to take necessary steps to prevent further injuries.

Hip stress fractures occur due to the following reasons:

• High-Impact Activities: A person involved in high-impact activities such as jumping, dancing, and involving significant stress on the hip joint is at risk of stress fractures.
• Sudden Increase in Activities: A sudden increase in the intensity of the activity can put a person under extra stress on the hip joint and increase the risk of stress fractures.
• Weakened Bones: Those with weakened bones such as those with osteoporosis are more prone to fractures in the hip and other bones.
• Anatomical Abnormalities: Discrepancy in leg length and hip impingement are some of the anatomical abnormalities that can increase the risk of stress on the hip joint and thereby hip fracture.
• Nutritional Deficiency: Low Levels of vitamin D and calcium can weaken the bones and increase the risk of fractures.
• Poor Technique or Form: Improper technique during any physical activity can increase the risk of injury. It may put extra stress on the hip joint and causes fracture.

The risk fractures for hip stress fractures include:⁽³⁾

• Age: As a person age the bones get weaker and more prone to hip stress fractures. Older adults are more prone to hip stress fractures.
• Sex: Females are more prone to hip stress fractures due to lower bone density and changes in hormone levels during menopause.
• Activity Level: People involved in high-impact activities are more prone to hip stress fractures.

Along with the above, people with lower bone density, nutritional deficiency, and a history of fractures are more prone to future fractures.

Some of the common symptoms of hip stress fractures include:⁽⁴⁾

• Dull, sharp pain in the hip and groin area that can worsen with activity.
• Tenderness to touch on the affected area.
• Presence of swelling in and around the hip joint.
• Pain and discomfort make it difficult to walk and stand and perform activities.
• Restriction in the range of motion of the affected hip.
• Worsening of pain even with low-impact activities.

The first step towards the diagnosis of hip stress fractures is a physical examination of the joint. The doctor assesses a person’s condition.

A hop test is performed that involves a person hopping on one foot to put pressure on the affected limb. If a person has pain in the injured region, the test is positive.

If during a physical examination, a stress fracture is suspected, tests are ordered, which include:⁽⁵⁾

• X-ray: It provides images of the dense bone structures and helps detect hip fractures
• Magnetic Resonance Imaging MRI scan: This test provides images of the bones and soft tissue structures and can detect small incomplete fractures.
• Computerized Tomography CT scans: CT scans provide a cross-sectional image of the hip. A CT scan is ordered if the MRI scan is unsuitable.
• Bone Scan: A bone scan is a nuclear medicine test that can detect fractures by injecting a small radioactive material into the bloodstream. The material is taken up by the bones and the areas with increased bone activity appear brighter. A bone scan is not usually the first choice for diagnosing hip stress fractures, and it is typically reserved for cases where other imaging tests are inconclusive.
• Ultrasound: Ultrasound helps view the soft tissue around the hip joint and can be helpful in detecting swelling and inflammation associated with hip fracture.

The non-surgical options for the treatment of hip stress fractures include:

• Rest: Resting the affected hip is important allowing it time to heal. Activities may exacerbate inflammation and also fracture.
• Ice Therapy: Ice application may reduce inflammation and swelling on the hip. It should be applied for 20 minutes, several times a day.
• Pain management: Over-the-counter pain medications can help in managing pain and reducing inflammation.
• Physical Therapy: Physical therapy can be helpful in restoring strength and flexibility. The physical therapy plan is tailored according to the individual needs.
• Crutches and Walker: Support devices such as crutches and walkers are used to relieve weight from the affected joint, allowing it to heal quickly.
• Modified Activities: Avoiding activities that aggravate the hip joint pain should be avoided. These activities may include running, jogging, or jumping.

In some cases, surgery may be necessary to treat hip stress fractures, although it is not typically the first-line treatment. If the non-surgical options fail to relieve pain or provide relief, surgical options are considered. The type of surgical options depends on the location, severity, and type of hip stress fracture.

• Internal Fixation: It involves using metal screws, plates, or rods to stabilize the bone. It is commonly used for hip stress fractures occurring in the femoral neck.
• Hip Arthroscopy: Hip arthroscopy is a minimally invasive procedure in which a thin camera and surgical instrument are inserted through a tiny incision in the hip.
• Osteotomy: It involves cutting and repositioning the joint to relieve pressure. This may help promote healing.
• Bone Grafting: Bone grafting involves taking bone from another part of the body or using a synthetic bone substitute to help support fractured bone and promote healing.
• Total Hip Replacement: This involves replacing the damaged hip joint with an artificial joint. It is used for severe stress fractures.

An orthopedic surgeon can determine the best surgical option depending on the symptom severity.

The recovery time for a hip fracture depends on the severity and location of the fracture as well as the age and overall health of an individual. Also, how an individual adheres to the treatment plan matters.

In general, the non-surgical treatment methods may show effectiveness around 6-12 weeks.

If a person undergoes surgery, a long time may be needed to recover, which may be 3-6 months.

It may take an individual several months to resume normal activities.

Following the treatment plan given by the doctor is important to ensure healing and avoid re-injury. Also, maintaining a healthy and balanced diet and regular exercise supports healing and prevent injuries.

Rehabilitation exercises and activities can be helpful in recovering faster from a hip stress fracture. These include:

• Range of Motion Exercises: This involves moving the hip joint through its full range of motion. It helps in maintaining flexibility and prevents stiffness.
• Strengthening Exercises: These strengthen the hip joint and support it preventing further injuries.
• Balance and Stability Exercises: Hip injuries affect balance and increase the risk of falls. Balance and stability exercises help in maintaining balance and stability.
• Low-Impact Aerobic Exercises: These exercises help improve the cardiovascular health and overall fitness of an individual without putting too much pressure on the hip joint.
• Sport-Specific Exercises: Individuals participating in sports or high-impact exercises need to work with a physical therapist or an athletic trainer to develop specific exercises to help them return to sports safely.

It is important to follow the guidance of a healthcare professional even while starting any rehabilitation exercise.

Certain precautions can be adopted to prevent hip stress fractures. These include:

• Gradually progressing activities
• Wearing proper footwear
• Eating a good, nutritious, and healthy well-balanced diet.
• Getting bone density checked regularly

Avoiding risk factors including smoking, excessive alcohol consumption, and certain medications as it can help in reducing the risk of fractures.

Early diagnosis and treatment can be helpful as they can prevent the fracture from getting severe. A severe fracture has a longer recovery time. Also, if not treated a stress fracture may worsen into a complete fracture.

Early treatment can help relieve pain and the associated discomfort. This can be helpful in improving the overall quality of life.

Hip stress fractures can be a serious condition that can have a significant impact on the individual’s daily life. The risk factors for it include overuse of the joint and osteoporosis along with the age and sex of an individual. It is important to seek early diagnosis and treatment to prevent further damage and improve the outcome.

Treatment may include physical therapy, rehabilitation, and in severe cases surgery.

It is important to work with a healthcare professional closely to develop an individual treatment plan and ensure recovery.