Hip Pain After a Fall but No Bruise: Could It Still Be Broken?

Can you break your hip without a bruise?

Yes. The hip joint sits deep under thick layers of muscle, so a break in the upper thighbone may not show on the skin at all. AAOS OrthoInfo notes that there may be a bruise on the outer hip or thigh where you landed, but that is not always the case, and the absence of one does not rule out a fracture.

The amount of force matters too. AAOS OrthoInfo explains that most hip fractures in older adults come from low-energy falls, such as tripping or twisting at home, when bones are weakened by osteoporosis. In some cases the bone is so weak that it breaks while a person is simply standing or walking, which is why doctors sometimes say "the break occurs before the fall." A minor fall with no bruise can still break a fragile hip.

Can you still walk with a broken hip?

Sometimes, and that surprises many people. With most hip fractures you cannot stand or move the leg. But AAOS OrthoInfo describes a smaller group of fractures, usually nondisplaced femoral neck fractures where the bone pieces stay lined up, that may not be very painful at first. People with these breaks may still move the leg and bear weight, even though it hurts.

This is exactly the situation where a fracture gets missed. Someone falls, feels sore, walks to the car and decides it is just a bruise. If an aligned fracture is loaded for days, it can shift out of position, which makes treatment more involved. Walking on the leg is not proof that the hip is intact.

What are the warning signs of a hip fracture after a fall?

Use this list to decide whether to get checked today. If more than one applies, go to an emergency room.

• Pain in the groin or upper thigh when you put weight on the leg
• The injured leg looks shorter than the other or is rolled outward
• Pain when you try to lift your heel off the bed or swing the leg
• You are over 60, have osteoporosis or have broken a bone in a minor fall before
• Pain that is getting worse over the hours after the fall instead of better
• A new limp or the need to use furniture or a cane to get around

Who is most at risk of breaking a hip in a fall?

Age and bone strength are the biggest factors. AAOS OrthoInfo reports that more than 300,000 people in the U.S. break a hip each year, and most are 65 or older and injured in falls at home or in the community.

Osteoporosis is a silent condition. AAOS OrthoInfo points out that it does not hurt, so many people do not know they have it until a bone breaks. The upper thighbone is one of the places where bone loss tends to be greatest. Other risks include long-term steroid use, a prior fracture from a minor injury, smoking, heavy alcohol use and balance problems.

If you are in one of these groups, treat any painful fall with extra caution. A same-day X-ray is a small price for peace of mind.

What if the X-ray is normal but your hip still hurts?

An X-ray is the right first test, and AAOS OrthoInfo notes that most hip fractures can be seen on one. A few cannot. Hairline breaks and impacted fractures, where the bone is pushed together, can hide on a first X-ray.

When pain with weight bearing continues and the X-ray looks normal, the next step is usually an MRI or CT scan. AAOS OrthoInfo explains that MRI is very sensitive and can show a small or incomplete fracture that does not appear on an X-ray. A normal X-ray with ongoing groin pain is a reason to keep looking.

What else can cause hip pain after a fall?

Not every painful fall means a broken hip. A direct hit on the side of the hip can bruise the deep tissues or inflame the trochanteric bursa, causing outer hip pain that is tender to touch. A fall can also strain a muscle, tear the labrum or flare existing hip arthritis. Falls onto the buttock can injure the tailbone, pelvis or lower back.

These problems are usually less urgent, but they can feel similar in the first few days. A hip specialist can sort them out with an exam and the right imaging.

What should you do after a fall that hurts your hip?

If you cannot stand, the leg looks deformed or shortened, or you are in severe pain, call 911 and do not try to walk. MedlinePlus advises emergency help when hip pain follows a serious fall or you cannot bear weight. If you can walk but still have groin pain with each step, get an X-ray the same day and use a walker or crutches until a fracture is ruled out.

If a fracture is found, most need surgery. AAOS OrthoInfo explains that surgery relieves the pain of the break and lets you get out of bed sooner, which helps prevent problems such as blood clots, bed sores and pneumonia. Depending on the type of fracture, the bone may be held with screws or a plate, or the ball of the hip may be replaced. A small number of aligned fractures in healthy patients can be treated with protected weight bearing and close monitoring.

If the X-ray is clear but the pain is not improving after a few days, an evaluation at Dr. Stride Hip & Joint can determine whether an MRI is needed. The Saturday Hip Pain Clinic in Memorial City is set up for exactly this kind of question. Bring the X-ray report and images with you, and our team will help you get a clear answer.

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