Hip and Pelvic Fractures

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Dr Kau Chung Yuan (许医生)


MRCS (Ireland)

MMed (Ortho)

FRCSEd (Ortho)


What are Hip and Pelvic Fractures?

Hip and pelvic fractures refer to breaks or cracks in the bones of the hip or pelvic area.

The hip is a ball-and-socket joint where the head of the femur (thigh bone) fits into the acetabulum, a part of the pelvic bone. The pelvis, located at the base of the spine, is a structure of bones comprising the ilium, ischium, and pubis.  Fractures in these areas can range from minor cracks to complete breaks, affecting one or multiple parts of the hip and pelvic bones.

Causes of Hip and Pelvic Fractures

Hip and pelvic fractures can be attributed to a variety of factors, which are generally categorised into traumatic causes, medical conditions, and other contributing factors.

Traumatic Causes
  • Falls: The most common cause of hip fractures in older adults. Even minor falls can lead to fractures in individuals with osteoporosis.
  • Vehicle Accidents: High-energy impacts, such as those in car or motorcycle accidents, often cause severe hip and pelvic fractures.
  • Sports Injuries: High-impact sports or activities can lead to hip and pelvic fractures through falls, collisions, or overuse.
Medical Conditions
  • Osteoporosis: A medical condition causing bones to lose density, become brittle, and more susceptible to fractures.
  • Bone Cancer or Metastasis: Cancer in the bones or spreading to the bones can weaken them, increasing the risk of fractures.
  • Osteomalacia and Rickets: Conditions resulting from vitamin D deficiency, leading to the softening of bones and a higher likelihood of fractures.
Other Factors
  • Age: The risk of hip and pelvic fractures increases with advancing age due to natural bone density loss.
  • Gender: Women, especially postmenopausal, are more prone to osteoporosis and related hip fractures.
  • Lifestyle Factors: Poor nutrition, limited exercise, and certain medications can weaken bones, elevating fracture risks.

Types of Hip and Pelvic Fractures

Hip and pelvic fractures can be classified into various types, each with unique characteristics and implications for treatment and recovery.

Hip Fractures

  • Femoral Neck Fractures: Occurs in the neck of the femur, just below the ball of the hip joint. Common in older adults, particularly those with osteoporosis.
  • Intertrochanteric Fractures: Located between the neck and the shaft of the femur, in the trochanteric region. These fractures often require surgical intervention.
  • Subtrochanteric Fractures: Found below the trochanter region, extending down the femur. They can be caused by high-energy trauma or stress in weakened bones.

Pelvic Fractures

  • Stable Pelvic Fractures: Involves one break in the pelvic ring with minimal displacement. Often caused by low-energy impacts and may be treated non-surgically.
  • Unstable Pelvic Fractures: Features multiple breaks in the pelvic ring with significant displacement. Usually results from high-energy trauma and typically requires surgical repair.
  • Acetabular Fractures: Involve the socket of the hip joint and can significantly affect the joint’s stability and function.

Stress Fractures

  • Insufficiency Fractures: Occur when normal stress is applied to a weakened bone, common in conditions like osteoporosis.
  • Fatigue Fractures: Result from repeated stress over time, often seen in athletes or military personnel.


The symptoms of hip and pelvic fractures can vary depending on the type and severity of the fracture, but there are common signs to be aware of.

  • Pain
    The most immediate and noticeable symptom, often severe and localised in the hip or groin area. Pain may also radiate to the lower back or down the leg.
  • Inability to Bear Weight
    Difficulty or inability to stand or put weight on the affected leg, often accompanied by instability or a feeling of the leg giving way.
  • Swelling and Bruising
    Visible swelling and bruising around the hip or pelvic area.
  • Abnormal Leg Position
    In severe fractures, the leg on the affected side may appear shorter and turned outward.
  • Limited Mobility
    Reduced range of motion in the hip joint, difficulty in moving the leg or hip, or pain during movement.

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Diagnosing hip and pelvic fractures involves a combination of clinical assessment and imaging studies.

  • Clinical Examination
    A healthcare professional will assess the patient’s symptoms, medical history, and conduct a physical examination. This may include checking for pain, swelling, bruising, and assessing the range of motion in the hip and leg.
  • X-rays
    The primary imaging tool for diagnosing fractures. X-rays can reveal the location, type, and extent of the fracture.
  • Computed Tomography (CT) Scan
    This may be used for more detailed imaging, particularly in complex fractures or when more information is needed beyond what X-rays provide.
  • Magnetic Resonance Imaging (MRI)
    Useful in detecting stress fractures and other injuries that may not be visible on X-rays.
  • Bone Scan
    Occasionally used to identify stress fractures, especially if other imaging tests are inconclusive.

Non-Surgical Treatment Options

Non-surgical treatment may be recommended for certain types of hip and pelvic fractures, particularly those that are less severe or stable.

  • Rest and Activity Modification: Limiting weight-bearing activities to reduce stress on the fracture site and allow healing. Crutches or a walker may be used to assist in mobility.
  • Pain Management: Analgesics, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can be prescribed to alleviate pain. In some cases, stronger pain medications may be necessary.
  • Physical Therapy: Once the fracture begins to heal, physical therapy plays a crucial role in restoring strength, flexibility, and range of motion. It also aids in improving balance and preventing falls.
  • Bone-Strengthening Medications: For patients with osteoporosis or at high risk of fractures, medications that strengthen bones may be prescribed to prevent further fractures.

Surgical Treatment Options

Surgical intervention is often necessary for more severe hip and pelvic fractures, particularly those involving displacement or instability.

Internal Fixation

Involves the use of metal plates, screws, or rods to hold the fractured bones in place until they heal. Common for fractures that are not significantly displaced.

Hip Replacement Surgery

In cases where the hip joint is damaged, a partial or total hip replacement may be performed. This is more common in older adults with joint wear.

External Fixation

Used for certain pelvic fractures, where a frame outside the body is connected to the bone with pins to hold it in place during healing.

Intramedullary Nailing

Involves inserting a metal rod into the marrow canal of the femur to stabilise subtrochanteric or femoral shaft fractures.

Pelvic Ring Surgery

For unstable pelvic fractures, surgical reconstruction of the pelvic ring may be necessary to restore stability and alignment.


Dr. Kau Chung Yuan

MBBS (S’pore)

MRCS (Ireland)

MMed (Ortho)

FRCSEd (Ortho)

Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.

He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.

  • Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
  • Master of Medicine (Orthopaedics), Singapore (MMed) 2013
  • Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
  • Bachelor of Medicine and Surgery (MBBS, Singapore) 2004

Prevention And Risk Reduction

Preventing hip and pelvic fractures involves addressing risk factors and implementing strategies to strengthen bones and reduce the likelihood of falls. This is especially important for older adults and those with conditions that weaken bone strength.

  • Regular Exercise
    Weight-bearing and muscle-strengthening exercises can help maintain bone density and improve balance, reducing the risk of falls.
  • Healthy Diet
    A diet rich in calcium and vitamin D supports bone health. Dairy products, leafy green vegetables, and fortified foods are good sources.
  • Fall Prevention Measures
    This includes making home safety modifications, such as removing trip hazards, installing grab bars, and ensuring adequate lighting.
  • Bone Density Screening
    Regular screening for osteoporosis can help identify individuals at risk and allow for early intervention.
  • Lifestyle Modifications
    Limiting alcohol consumption, quitting smoking, and maintaining a healthy weight contribute to overall bone health.
  • Medications to Strengthen Bones
    For those with osteoporosis, medications such as bisphosphonates can reduce the risk of fractures.

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Patient Feedback

Ethan Chan
Dr. Kau is an exemplary doctor who is experienced in his field and is very patient with his patients. He walked me through the details of my knee condition and addressed all my concerns. Thanks to Dr. Kau, I had a better understanding of my ACL and MCL injury and the various treatment options available. His advice and treatment have been very valuable to me.
Ming Lee Chua
Dr Kau was very careful and explained clearly the surgery procedures. After surgery, the care while I was in hospital was closely monitored and he even came during weekends! The hip so far has recovered and healed. His ‘predictions’ of when what can happen are so accurate. Trust him.
Teo Pek Suan Diana
I had a very successful total hip replacement done by Dr Kau 4 years ago. 4 months after the operation I was back walking, cycling and swimming. The beautiful job gave me much confidence Dr Kau is most professional and has such great doctor patient communication.

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    Frequently Asked Questions (FAQs)

    How long does it take for a hip or pelvic fracture to heal?

    The healing time for hip or pelvic fractures can vary significantly based on several factors. Minor fractures can heal within several weeks, while more complex or severe fractures may take several months or longer.

    What are the risks of not treating a hip or pelvic fracture?

    Leaving a hip or pelvic fracture untreated can lead to severe and long-lasting complications. Chronic pain and discomfort are common, as the fracture may not heal properly, leading to misalignment and abnormal stress on adjacent muscles and joints. Untreated fractures can disrupt blood flow, increasing the risk of blood clots.

    Will I be able to walk normally again after a hip or pelvic fracture?

    The ability to walk normally after a hip or pelvic fracture largely depends on the severity of the fracture, the effectiveness of the treatment, and the patient’s commitment to rehabilitation.

    Many patients can regain normal walking abilities, especially with early and appropriate treatment followed by targeted physical therapy. However, the outcome can vary, and some individuals may experience residual stiffness, reduced range of motion, or a slight alteration in their gait.

    What are the long-term effects of a hip or pelvic fracture?

    Some individuals may experience ongoing discomfort or chronic pain in the hip or pelvic area. Reduced mobility and a decrease in the range of motion of the hip joint are also common, which can affect daily activities and independence. There is also an increased risk of arthritis in the affected joint in the years following the fracture.