How do you fall when you break a hip?

So, Thanksgiving morning I fell on ice for the first time in many years, and as I almost always have in the past, I landed on my hands and knees. My scrapes and bruises have long since healed but thinking about this today makes me wonder about how people fall when they break a hip.

I can only think of one occasion when falling didn’t mean landing on my hands and knees, and that time I broke my tailbone, but even that didn’t bother my hips. So as we age do we end up falling differently when we unexpectedly lose our footing? Directly onto our hips? Or does falling onto your hands and knees (or just knees) or your butt lead to damaging your hips too when we’re older and have weaker bones?

Sometimes, in elderly people who break a hip, the hip breaks and then you fall because you lose stability. The bones have become so fragile they fracture under their own weight.

That would be a rather extreme example. Most elderly folk have some degree of bone density loss (more prevalent in females). The various medical issues that crop up as we age make it more likely that we may suffer from some combination of failure of equilibrium, and or loss of visual acuity making it more difficult for us to see or navigate obstacles, stairs, etc.

So we become more prone to falling, as well as more likely to break bones. The hip joint is subject to massive amounts of force in many fall scenarios, us younguns are just less likely to break or dislocate it.

**How do you fall when you break a hip?


My mom bounces …


She just fell for the second time in 4 months about 2 weeks ago, didn’t break a damned thing either time :eek:

We figure it is for a couple reasons - firstly while she did grow up in the depression, she lived on a farm that had cows and raised most of the food for the family themselves, so she had killer good nutrition, plenty of milk in the formative years as well as some fairly hard labor as this was when everybody pitched in and worked. Then as an adult, she had a good diet with plenty of cheese and dairy [I swear we are all cheese addicts in the family] and a good variety of foods, with almost no junk food. She just has really solid bones, the way I have good solid bones from good diet and previously having worked a heavy labor job that built up my bone density.

The hip joint is exposed on the side - there is no large muscle covering it.
So its the fall to the side… Even if they fall forward they use one leg to try to break their fall, and develop a twisting motion.

My mother, who is in her mid-70s, fell and broke her hip yesterday. I wasn’t there to witness it, but it was from standing height and involved losing her balance while turning to one direction, so there was a twisting motion.

I would think age would also slow your reflexes. So where a younger person can respond to a slip and fall in a somewhat protective way–like onto hands and knees–an older person just keeps going in the direction of the slip and lands much more awkwardly.

About 20 years ago I read an article about a researcher at Northwestern University who had similar doubts about falling and breaking your hip. So he did what any good researcher would do: got a lot of old people to walk around and see what happened when they fell.
He had them rigged to harnesses that would catch them before they hit the ground, and then had them walk while he studied and filmed them.

His conclusion was that folks were confused about the sequence of events. If you are walking along, experience a loss of balance, fall to the ground, and then have a broken hip, you “fell and broke you hip”, when a far more likely explanation is that you broke your hip and fell.
I believe he also studied x-rays from emergency room visits, and found the breaks usually were consistent with torquing of the joint, rather than an external impact.

However, more on the original point: I have had my fair share of slip-and-fall incidents. I usually end on my rear, and once broke my tailbone, but I have at least once landed on my side with a deep bruise on my hip. So you don’t need to be old and slow to wind up falling awkwardly, although I imagine it helps.

The research I can find …

Indeed directly on the side of their hipswithout breaking the fall.

My guess would include that reflexes and coordination are poor especially in those most prone to falling and getting the hand out to catch themselves is much less likely to happen than in a younger population. They also appear to be more likely to have visual difficulties.Medications may also play a part.

I can’t find anything that suggests the break occurs before the fall.

Second this. Someone crashed into the side of me while ice skating and I landed on my hip with virtually no bracing at all.
Of course, in normal circumstances, few things make us fall like that, but if you couple poor balance with slow reactions I can believe that sideways or twisting falls are more common in the elderly.

And given the force that I fell on to my hip, I’d think the chance of injury would be quite high for this group for this kind of fall.

When people refer to “Breaking a hip”, they generally mean fracturing the neck of the femur. Referred to as a fractured NOF.

If you look at a pic of a femur, you have the big thick bone, with the ball on the end (which is the part that goes into the hip socket). The skinny bit before the ball is the NOF and that’s the bit that usually breaks.

It’s an old persons injury, made prevalent by brittle aged bones. You don’t have to “Fall” any particular way.

When my mother broke hers, she was on the beach after snorkeling, and had not taken off her fins yet. She stepped on one of them with the other foot, twisted, and went down. :frowning:

My wife’s grandfather broke his hip when he fell. He was going to the doctor with his wife, he was 86. He went to open the door for her, missed the handle, so he pulled on thin air and landed apparently more on his side than his butt. He cracked, I assume as Stu mentions, either the neck of the femur, the socket it sits into, or both.

It helps if you do this in the hospital. Fortunately, he did not have to wait for them to call an ambulance crew to carry him through the door (true story - has happened in Canada!). And, at 86 with mild Alzheimers, he got a replacement mechanical hip that night courtesy of the provincial health plan. Total cost to him, zero dollars.

Sadly, he developed severe infection and almost died during the next week, but within a month he was using a walker and back in the home. Unfortunately, he never completely recovered his health from the infection, within a year he was back in hospital and died six months later.

True, but some types/directions of falls make a fracture much more likely. Indeed, from the (pretty good) Wki link one learns:

(reference for quoted risk above)

So it’s not from old women engaging in vigorous sex?:smiley: Seriously, I’ve always heard tongue in cheek that this was a concern.

This. My dad (79YO) has Parkinson disease, which affects motor control and also cognition. On top of that he is prone to orthostatic hypotension, i.e. he sometimes gets dizzy briefly after standing up. At one point last summer he was sat on a bench while tying his shoes; he stood up, became dizzy, and stumbled backwards. The bench was right behind him, and there was a wall behind that and another wall to his left - but he never actively braced himself against anything, he just stumbled backwards into all three items and sat down rather violently on the bench (uninjured). Seeing that happen, it’s not hard to imagine that a simple slip or trip in other circumstances could easily result in a fall from standing height without taking any measures to slow the speed of impact.

The mechanism for fracture of the hip can be either. I personally think that most elderly break their hip and then fall. I know this is what happened to my mother-in-law. She started to fall but was held up by a relative behind her. So she had an intertrochanteric fracture without trauma.

Older folks have poorer balance, strength, bone density, reaction time, vision etc. I see falls (I’m a subacute rehab nurse), mostly to the side. A hip fracture is usually a femoral neck fracture. People absolutely break their hips then fall but the ortho surgeons I deal with seem to feel it’s usually fall then break. Area rugs, especially in the bathroom, are super dangerous. Bathrooms are deathtraps; enclosed area, slippery surfaces and several big hard objects for you to smack your head upon. Those are the ones who have brain bleeds too. Install brighter light bulbs and grab bars for Mom, please? Walking dogs and coming out of church (that’ll teach 'em ;)) are the other most common stories I hear.