Proximal Femur (Hip) FractureHip Fracture (Femoral Neck) (Proximal Femur (Hip) Fracture)
Proximal Femur (Hip) Fracture — Overview
Proximal femur (hip) fractures—classified into intracapsular femoral neck (Garden I–IV, carrying high risk of retinacular vessel disruption and femoral head avascular necrosis) and extracapsular intertrochanteric fractures—are treated via internal fixation (PFNA/DHS) or hip arthroplasty.
A proximal femur fracture (hip fracture) is a break in the upper neck or trochanter region of the thighbone near the hip socket, typically repaired surgically with a prosthesis or nail so you can stand and walk safely again.
Primary Causes & Biomechanics
Key Points You Should Know
- •Low-energy falls in older adults with osteoporosis, impaired balance, and sarcopenia, or high-energy trauma in young adults
- •Severe postoperative quadriceps and gluteus medius arthrogenic inhibition leading to Trendelenburg gait and fall recurrence
- •High risk of deep vein thrombosis (DVT), pulmonary embolism, pneumonia, and pressure ulcers during immobility
- •Hourly Ankle Pumps: Pumping your feet up and down in bed keeps blood flowing and prevents dangerous blood clots.
- •Hip Safety Precautions: If you had a hip replacement, never bend your hip past 90 degrees, cross your legs, or twist your foot inward.
- •Side Hip Strength: Strengthening your outer hip muscles eliminates limping and prevents future falls.
Assessment Methods
1. Goniometric ROM & Postural / Kinematic Analysis
Hip flexion (strictly <90° after posterior arthroplasty), extension (0–15°), abduction (0–40°), and knee ROM.
2. Special Clinical Provocation & Neurological/Functional Tests
Trendelenburg sign (once full weight-bearing is cleared), distal pedal pulses, DVT calf screening, and leg-length discrepancy measurement.
3. Standardized Clinical Outcome Scales & Imaging Criteria
Harris Hip Score (HHS), Barthel Index, Timed Up and Go (TUG), Berg Balance Scale (BBS), and AP/lateral hip radiographs.
1. Range of Motion & Posture Check
Your physiotherapist gently evaluates how comfortably and smoothly your proximal femur (intracapsular femoral neck and extracapsular intertrochanteric/subtrochanteric regions) moves and checks your overall posture.
2. Muscle Strength & Functional Movement Check
Your muscle balance, walking or reaching comfort, and specific gentle movement tests are evaluated without triggering sharp pain.
3. Typical Symptoms & Daily Impact Review
Pre-operative shortened and externally rotated lower extremity with inability to bear weight; post-operatively, groin/lateral hip surgical pain, thigh edema, and gluteal/quadriceps weakness.
Treatment Options & Phase-Based Protocol
✨ Enriched GIF Exercise & Precaution GuidePhase 1: Acute Symptom Modulation, Tissue Protection & Early Activation
- •Phase 1 Clinical Focus & Tissue Protection: Acute Post-Op Inpatient Phase (Days 1–14): Hourly ankle pumps and breathing exercises for DVT/atelectasis prophylaxis, isometric quadriceps & gluteal sets, supine heel slides (<90° hip flexion), and walker-assisted mobilization per surgeon's weight-bearing order (WBAT/PWB/NWB).
- •Pain, Edema & Neuromuscular Modulation: Targeted physical modalities, relative load management, and early protected mobility of the proximal femur (intracapsular femoral neck and extracapsular intertrochanteric/subtrochanteric regions) without provoking mechanical or inflammatory irritation.
- •Proximal & Distal Kinetic Chain Maintenance: Maintain active mobility and circulation in adjacent joints while protecting the primary healing structures in Proximal Femur (Hip) Fracture.
Phase 2: Progressive Mobility, Motor Control & Targeted Strengthening
- •Phase 2 Progressive Mobilization & Motor Control: Subacute Strengthening & Transfer Phase (Weeks 2–6): Seated terminal knee extension, chair sit-to-stand transfers (from a raised seat with abduction pillow precautions if arthroplasty), and supported standing hip abduction.
- •Biomechanical Alignment & Co-Contraction: Restore balanced agonist-antagonist force couples, joint centration, and multi-planar neuromuscular control across the proximal femur (intracapsular femoral neck and extracapsular intertrochanteric/subtrochanteric regions).
- •Myofascial Extensibility & Endurance: Address secondary compensatory tightness and build local muscular endurance within safe, symptom-free biomechanical parameters.
Phase 3: Functional Integration, Proprioception & Long-Term Prevention
- •Phase 3 Functional Integration & Long-Term Prevention: Balance, Gait Normalization & Fall Prevention (Week 6–12+): Progressive resistance training for gluteus medius/maximus and quadriceps, tandem/weight-shift balance training, cane weaning, and home hazard modification.
- •Proprioceptive Balance & Dynamic Loading: Progress to task-specific closed-chain, balance, and functional movement patterns tailored to daily life, occupational, or athletic demands.
- •Self-Management & Relapse Prophylaxis: Establish lifelong ergonomic habits, home exercise maintenance, and early warning-sign awareness to prevent recurrence.
Step 1: Calming Pain, Protecting the Area & Gentle Starter Motion
- •Hourly Ankle Pumps: Pumping your feet up and down in bed keeps blood flowing and prevents dangerous blood clots.
- •Calm Protection & Gentle Start: During the initial stage of Hip Fracture (Femoral Neck), avoid painful overloading and perform the gentle, pain-free starter movements shown below to support circulation and comfort.
- •Respecting Your Body's Signals: Every movement should stay within a comfortable, non-painful zone—never force through sharp or radiating pain.
Step 2: Restoring Flexibility & Building Supporting Muscle Strength
- •Hip Safety Precautions: If you had a hip replacement, never bend your hip past 90 degrees, cross your legs, or twist your foot inward.
- •Step-by-Step Flexibility & Support: As acute sensitivity settles, gradually build mobility and strengthen the supporting muscles around the joint at a steady, controlled pace.
- •Posture & Breathing Coordination: Keep your posture upright and breathe smoothly (never hold your breath!) during every repetition.
Step 3: Safe Daily Habits, Stamina & Preventing Recurrence
- •Side Hip Strength: Strengthening your outer hip muscles eliminates limping and prevents future falls.
- •Confident Return to Daily Life: Integrate your stronger muscles and improved balance into walking, stairs, work, and recreational activities.
- •Preventing Future Flare-Ups: Continue your core protective habits and key maintenance exercises even after symptoms resolve.
Animated (GIF) Therapeutic Exercise Guide
Animated clinical exercise protocol with biomechanical angles, target muscle groups, and dosage parameters (Click image to enlarge)
Step-by-step animated exercise demonstrations you can safely perform at home (Click image to enlarge)
🔍 Enlarge1. Rhythmic Active Ankle Dorsiflexion & Plantarflexion Pumping (Venous/Edema Pump)
1. Ankle Toe-Pulls and Pointing (Circulation & Swelling Pump)
Rhythmic alternating contraction of the tibialis anterior and gastrocnemius-soleus complex. Activates the deep venous calf pump to prevent deep vein thrombosis (DVT), clears distal edema, and maintains talocrural mobility. Specifically indicated in Proximal Femur (Hip) Fracture rehabilitation to optimize proximal femur (intracapsular femoral neck and extracapsular intertrochanteric/subtrochanteric regions) biomechanics and neuromuscular control.
While lying down or sitting with your legs supported, pull your toes and feet firmly upward toward your shins, hold for 3 seconds, then point them downward like pressing a gas pedal. Perform smoothly within a comfortable, pain-free range to support your Hip Fracture (Femoral Neck) recovery.
🔍 Enlarge2. Supine Active-Assisted Heel Slide & Synovial Diffusion Mobilization
2. Supine Heel Slide (Gentle Knee & Hip Bending)
Controlled flexion and extension of the lower extremity by sliding the heel along the support surface without axial weight-bearing. Stimulates synovial fluid diffusion across avascular cartilage and prevents capsular adhesions. Specifically indicated in Proximal Femur (Hip) Fracture rehabilitation to optimize proximal femur (intracapsular femoral neck and extracapsular intertrochanteric/subtrochanteric regions) biomechanics and neuromuscular control.
While lying on your back, slowly slide your heel along the bed sheet toward your hip within a comfortable, pain-free angle, hold for 3 seconds, and gently slide it back out straight. Perform smoothly within a comfortable, pain-free range to support your Hip Fracture (Femoral Neck) recovery.
🔍 Enlarge3. Supported Standing Hip Abduction & Closed-Chain Stance Stabilization
3. Counter-Supported Standing Side Leg Lift
Standing upright with light hand support, abducting the lower limb in the frontal plane while the stance-leg gluteus medius contracts isometrically to keep the pelvis level. Builds functional gait stability. Specifically indicated in Proximal Femur (Hip) Fracture rehabilitation to optimize proximal femur (intracapsular femoral neck and extracapsular intertrochanteric/subtrochanteric regions) biomechanics and neuromuscular control.
Hold lightly onto a sturdy counter or chair back and stand tall. Without leaning your trunk sideways, lift your leg out to the side, pause for 2–3 seconds, and slowly return. Perform smoothly within a comfortable, pain-free range to support your Hip Fracture (Femoral Neck) recovery.
🔍 Enlarge4. Functional Closed-Kinetic-Chain Chair Transfer (Sit-to-Stand Biomechanics)
4. Controlled Chair Sit-to-Stand Transfer
Controlled transition from sitting to standing and eccentric lowering back to the chair with symmetrical weight distribution, anterior trunk inclination ('nose over toes'), and neutral frontal knee alignment. Specifically indicated in Proximal Femur (Hip) Fracture rehabilitation to optimize proximal femur (intracapsular femoral neck and extracapsular intertrochanteric/subtrochanteric regions) biomechanics and neuromuscular control.
Sit near the front of a sturdy chair with your feet hip-width apart. Lean slightly forward and push evenly through both heels to stand up tall, then slowly lower yourself back down over 3 seconds. Perform smoothly within a comfortable, pain-free range to support your Hip Fracture (Femoral Neck) recovery.
🔍 Enlarge5. Isometric Quadriceps Setting (Popliteal Towel Press)
5. Under-Knee Towel Press (Quadriceps Tightening)
Isometric compression of a rolled towel beneath the popliteal fossa into the surface with simultaneous ankle dorsiflexion. Activates the Vastus Medialis Obliquus (VMO) and overcomes arthrogenic muscle inhibition with 0° joint shear stress. Specifically indicated in Proximal Femur (Hip) Fracture rehabilitation to optimize proximal femur (intracapsular femoral neck and extracapsular intertrochanteric/subtrochanteric regions) biomechanics and neuromuscular control.
Place a small rolled towel under your knee while lying on your back or sitting with your leg straight. Pull your toes toward you while firmly pressing the back of your knee down into the towel, hold for 5 seconds, and relax while exhaling. Perform smoothly within a comfortable, pain-free range to support your Hip Fracture (Femoral Neck) recovery.
🔍 Enlarge6. Single-Leg / Semi-Tandem Proprioceptive & Weight-Shift Balance Training
6. Supported Weight-Shifting & Tandem Balance Practice
Controlled mediolateral/anteroposterior weight shifting and tandem or single-leg stance near a stable support. Enhances mechanoreceptor feedback, ankle/hip postural reflexes, and dynamic gait stability. Specifically indicated in Proximal Femur (Hip) Fracture rehabilitation to optimize proximal femur (intracapsular femoral neck and extracapsular intertrochanteric/subtrochanteric regions) biomechanics and neuromuscular control.
Stand near a counter or sturdy chair for safety. Place one foot slightly in front of the other (or shift your weight smoothly from side to side) and hold your balance upright for 20–30 seconds. Perform smoothly within a comfortable, pain-free range to support your Hip Fracture (Femoral Neck) recovery.
Movements to Avoid & Strict Precautions
1. Hip Flexion >90°, Leg Crossing (Adduction) & Internal Rotation (Arthroplasty Rules!)
1. Bending your hip past 90 degrees, crossing your legs, or sitting on low sofas/toilets
2. Exceeding the Surgeon's Prescribed Weight-Bearing Limit (NWB / PWB / WBAT)
2. Stepping with more weight on your operated leg than your surgeon permitted
3. Pivoting on the Operated Foot While Turning
3. Twisting your body while your operated foot stays planted on the floor
4. Prolonged Bed Rest Without Ankle Pumps and Breathing Exercises
4. Lying completely still in bed for hours without moving your ankles and taking deep breaths
Proximal Femur (Hip) Fracture — Video Guide
Click directly on any video to open and watch in a window, or review details via 📋 Summary & Options.
Condition Overview Video (1 Video)
Summary of pathophysiology, biomechanics, and clinical presentation
What the condition is, why it develops, and its basic mechanism
Treatment Options in Femoral Neck and Hip Fractures
Proximal femur (hip) fractures—classified into intracapsular femoral neck (Garden I–IV, carrying high risk of retinacular vessel disruption and femoral head avascular necrosis) and extracapsular intertrochanteric fractures—are treated via internal fixation (PFNA/DHS) or hip arthroplasty.
A proximal femur fracture (hip fracture) is a break in the upper neck or trochanter region of the thighbone near the hip socket, typically repaired surgically with a prosthesis or nail so you can stand and walk safely again.
Treatment and Exercise Videos
Phase-based physiotherapy protocols, mobilization, and therapeutic exercises
Step-by-step recovery and safe home exercise applications
Physical Therapy Exercises After Hip Fracture and Hip Surgery
Phase 1: Acute Symptom Modulation, Tissue Protection & Early Activation: Phase 1 Clinical Focus & Tissue Protection: Acute Post-Op Inpatient Phase (Days 1–14): Hourly ankle pumps and breathing exercises for DVT/atelectasis prophylaxis, isometric quadriceps & gluteal sets, supine heel slides (<90° hip flexion), and walker-assisted mobilization per surgeon's weight-bearing order (WBAT/PWB/NWB).
Step 1: Calming Pain, Protecting the Area & Gentle Starter Motion: Hourly Ankle Pumps: Pumping your feet up and down in bed keeps blood flowing and prevents dangerous blood clots.
Strengthening Exercises Following Lower Extremity and Leg Fractures
Phase 2: Progressive Mobility, Motor Control & Targeted Strengthening: Phase 2 Progressive Mobilization & Motor Control: Subacute Strengthening & Transfer Phase (Weeks 2–6): Seated terminal knee extension, chair sit-to-stand transfers (from a raised seat with abduction pillow precautions if arthroplasty), and supported standing hip abduction.
Step 2: Restoring Flexibility & Building Supporting Muscle Strength: Hip Safety Precautions: If you had a hip replacement, never bend your hip past 90 degrees, cross your legs, or twist your foot inward.
Clinical Assessment, Goniometry & Special Test Videos
Displayed only in Healthcare Professional mode (hidden in Patient mode)
Hip Joint Goniometric Measurement (Flexion, Extension, Abduction, Rotations)
Goniometric ROM & Postural / Kinematic Analysis: Hip flexion (strictly <90° after posterior arthroplasty), extension (0–15°), abduction (0–40°), and knee ROM.
Berg Balance Scale — Fall Risk and Postural Control Exam After Hip Fracture
Special Clinical Provocation & Neurological/Functional Tests: Trendelenburg sign (once full weight-bearing is cleared), distal pedal pulses, DVT calf screening, and leg-length discrepancy measurement.