A broken femur, the largest and strongest bone in the human body, represents a major medical trauma for older adults. The seriousness of this injury stems less from the break itself and more from the underlying frailty and medical complexity of the patient. In this demographic, these fractures are overwhelmingly caused by low-energy mechanisms, such as a simple fall from a standing height, often pointing to underlying conditions like severe osteoporosis. A femur fracture is not merely an orthopedic issue; it is a systemic health crisis that requires immediate, aggressive, and specialized medical attention.
Types of Femur Fractures Common in Older Adults
The severity and treatment of a femur fracture depend significantly on its precise location within the bone. In older adults, the vast majority of these injuries occur in the proximal femur, the upper portion that forms the hip joint, which is why they are commonly referred to as hip fractures. These proximal fractures are primarily classified into two types: femoral neck fractures and intertrochanteric fractures.
A femoral neck fracture occurs one to two inches from the hip joint, within the capsule that surrounds the joint. This location is particularly concerning because the break can disrupt the blood supply to the head of the femur. If the blood flow is compromised, the bone tissue can die, a complication known as avascular necrosis, which often necessitates a total hip replacement.
The second common type, an intertrochanteric fracture, happens slightly lower, between the greater and lesser trochanters, which are bony prominences where strong muscles attach. Unlike neck fractures, the blood supply to the bone is generally preserved in this region, making the repair method, typically internal fixation with a plate or rod, generally simpler. Fractures of the femoral shaft or the distal end near the knee are far less frequent in the elderly from low-energy falls.
Immediate Medical Intervention and Goals
Due to the systemic nature of the injury in older patients, the primary goal of acute medical care is rapid stabilization and surgical repair. Experts recommend that surgery take place as quickly as possible, ideally within 24 to 48 hours of admission. Delaying the operation beyond this window is consistently linked to increased rates of morbidity, prolonged hospital stays, and higher mortality.
Pain management is a top priority before and immediately after surgery, often achieved using regional techniques like a femoral or fascia iliaca nerve block to reduce the need for high doses of systemic opioids. The choice of surgical procedure is guided by the fracture type. A displaced femoral neck fracture often requires a hemiarthroplasty or total hip replacement, while intertrochanteric fractures are most often treated with internal fixation. The goal of the procedure is to provide stable fixation that allows the patient to begin early mobilization.
Unique Systemic Risks and Complications During Recovery
The most profound danger of a broken femur in an older adult is the cascade of life-threatening systemic complications that arise from trauma, surgery, and subsequent immobility. These issues, rather than the orthopedic injury itself, are the main drivers of poor outcomes and mortality in this patient group. Immobility is a major catalyst for deep vein thrombosis (DVT), where blood clots form in the deep veins of the leg. These clots can break loose and travel to the lungs, causing a potentially fatal pulmonary embolism (PE).
Prolonged bed rest also severely impairs respiratory function, leading to a high risk of hospital-acquired infections like pneumonia. Furthermore, the stress of the trauma and surgery can destabilize pre-existing medical conditions, significantly increasing the likelihood of cardiac events. Cognitive function is also highly vulnerable, with acute delirium being a common and serious complication that can impede recovery and worsen long-term cognitive decline.
The acute hospital stay is a particularly high-risk period, as most non-orthopedic complications, such as urinary tract infections (UTIs), pneumonia, and cardiac events, typically manifest within the first two weeks following surgery. Preventing these complications requires meticulous, multidisciplinary care, including aggressive respiratory therapy, early and consistent movement, and careful fluid and nutritional management. Malnutrition, which is highly prevalent in this patient population, is an independent predictor of increased mortality and postoperative complications.
Long-Term Prognosis and Functional Outlook
The long-term prognosis following a femur fracture underscores the severity of the injury, as it frequently marks a significant decline in health and independence. The mortality rate is notably elevated, with statistics showing that between 25 and 37% of older adults die within one year of sustaining a hip fracture. This increased mortality is often attributed to the severe systemic complications and the frailty that made the patient susceptible to the fracture in the first place.
For those who survive, the path to regaining function is long and arduous, requiring mandatory, intensive rehabilitation that may be in an inpatient facility before transitioning to outpatient therapy. Only 40 to 60% of elderly patients successfully return to their pre-fracture level of mobility and ability to perform daily living activities. Many patients experience an increased dependency on walking aids and a decrease in the likelihood of living independently at home, often requiring a move to long-term care facilities. Functional recovery can continue for up to a year, but the majority of functional improvement typically plateaus around six months post-injury.