How Long does it Take to Walk Normally after Hip Fracture?

A brief overview of hip fractures

Fractures of the femur occur most frequently following a fall from its height, especially in the elderly. In younger people, it often occurs during a traffic accident or while playing sports.

The femur can break in several places. But most often, it breaks at the neck, at the top, at the hip.

This is why it is called a hip fracture.

The diagnosis is made with the help of an x-ray, after a doctor has examined you. The X-ray is then often shown to an orthopedic surgeon. This professional will give his or her opinion on the most appropriate treatment based on:

• the precise location of the fracture ;
• the person’s state of health, age and history
• the person’s habits.

This could be :

• most often, surgery, with the placement of a gamma nail, a total or intermediate hip replacement or another type of fixation (often screws);
• a return home the same day with a follow-up appointment for a consultation and an X-ray 6 weeks later. And possibly a prescription for physiotherapy sessions at home or elsewhere ;
• a hospitalization of a few days in an orthopedic and traumatology department;
• a stay in a follow-up care and rehabilitation center.

Usually, by this point, the medical professionals who took care of you have explained if and how you are allowed to walk…. That’s what we’ll see now 🙂 .

What do we mean by “walking” after a hip fracture?

Let’s agree on one thing right away: “walking” means moving on one or more of one’s legs, whether or not one uses a technical aid. One can walk even :

• on one foot only ;
• with a limp ;
• with a splint;
• with a walker or crutches;
• between parallel bars in a physical therapy room.
• In short: there are many different ways to walk!

After a hip fracture, in the vast majority of cases (more than 99% in my experience) people will be able to walk the same day or in the following days. It’s just that the way they walk will be different depending on the instructions they receive!

3 types of walking after a hip fracture

In the days following a fractured hip, you will be able to walk. But not immediately as before: without a cane, without a limp. You will have to adapt the way you walk, to :

• avoid pain ;
• compensate for the loss of muscle strength due to the fracture or the surgery;
• in some cases, to facilitate bone healing.

Here are the 3 main types of walking adopted. From the most frequent to the least frequent. We will see in the next part how to know if in your case you should rather “walk” this way or that way.

1. Full weight bearing: You walk with both feet on the ground. You use crutches or a walker to relieve some of the weight on the fractured side. However, you press on it as much as you want. What limits you is simply your possible pain. As the days go by, you put less and less pressure on the crutches or walker. Until you gradually stop using them. Generally, after 4 to 10 weeks. We talk about “full support”, because you press as much as you want on the fractured leg.
2. Partial weight bearing: You walk with both feet on the ground. You use crutches or a walker to relieve a lot of pressure on the fractured side. In fact, you put a lot of weight on the canes or the walker. You barely put your foot on the ground, and you don’t put your full body weight on it. This is called partial support, or contact support. Usually, a physiotherapist will explain to you how to walk this way. After a few minutes or days, it will become intuitive for you. In general, you will have to walk like this until the control X-ray, 6 weeks after the fracture.
3. No weight bearing: You walk without putting your fractured foot on the ground at all. With or without a splint. You can still walk with crutches or a walker (or walking frame), if you are comfortable. You will walk without weight bearing to the control radio most of the time.

What will determine whether you will be allowed to walk with or without weight bearing? It’s the stability of your fracture (not the consolidation: nobody consolidates in a few days).

💡 You can use a scale to see if you are putting a lot of weight on the fractured leg or not. Put the operated foot on a scale, the other foot on a flat surface at the same height as the scale (take old books or solid wooden boards to be at the same height; see classic scales on Amazon). If you are only allowed contact support, you should theoretically put less than 5-10% of your body weight. Say, 10-20 kg maximum.

Let’s see how to know if you are allowed full weight bearing, contact/partial weight bearing or no weight bearing.

Can elderly (or younger) walk after hip fracture? How to know?

Didn’t the health professionals you saw tell you anything specific about walking? They never “forbade” you to put your foot on the ground, or told you that you should no weight bearing?

In this case, the probability is extremely high that you have the right to walk in full support: you press as much as you want, only the pain limits you. There is no need to go looking for “the little beast further”. If you have any doubts, you can possibly :

• look at the surgical report (if you have been operated) and all the documents that you have had following your treatment: report of the passage to the emergency room or hospitalization, prescription for the physiotherapists/nurses, letter to the attending physician, report of the X-ray. If there is nothing written on it regarding walking, or if it is written “full weight bearing authorized”, it means that it is good, you can walk “freely”. Only the pain should guide you;
• call your attending physician or the secretary of the physician who diagnosed the fracture to ask for clarification on this subject.

Did your professionals “warn” you about walking? Did they talk to you about partial weight bearing, or no weight bearing? Respect their instructions. If this seems too difficult or inappropriate, discuss it with the physiotherapists or doctors who are following you to consider alternatives.

If you are not allowed to put much (or any) weight bearing on the fractured hip, this will be marked somewhere in your discharge letters. Something like “no walking” (even if you can hobble), “partial weight bearing” or “no weight bearing”.

How long does it take to walk normally after hip fracture?

Regardless of the type of fracture and management you received, you will have a follow-up x-ray at a distance from the fracture. The purpose of this X-ray is to see if bone healing is well underway. If a surgery has been performed, it also allows us to check that the surgical material has not moved.

This X-ray is often performed 1.5 months after the fracture. Sometimes, 2 or even 3 months later.

In general, the results of this X-ray are good: you are beginning to healing well. In this case, you will be able to :

• gradually let go of the crutches (or walker) if you still have them ;
• gradually start to support yourself a little more over the days or weeks, if you were in contact support or partial support.

In the latter case, during the follow-up appointment, the surgeon will indicate on a prescription intended for the physiotherapist how the gradual resumption of support should take place. He will indicate something like :

• Progressive weight bearing, +10 kg per week, or +10% of body weight per week;
• Progressive weight-bearing according to pain;
• Full weight bearing

Your physiotherapist will be there to help you interpret this information if it is not clear enough for you.

Over the weeks and months after hip fracture, you will learn to walk normally again, unaided, without limping or technical assistance!

Is it possible to have a hip fracture and still be able to walk?

Another situation in which you may find yourself is that you have fallen, and your hip is very sore. But you can still walk. You didn’t go for an X-ray. Or you did, but they didn’t give you an x-ray, or they did, but you’re afraid they might have missed something.

And you’re wondering, does walking mean I don’t have anything broken? Clearly, no, that’s not good enough. I have several examples of people who have managed to walk after breaking their femur (often only to call for help).

What to do?

If you have already consulted a health professional, he or she has ruled out a fracture. You should gradually be able to walk more normally. Wait a few more days, and reconsult if there is really no improvement.

If you have not consulted a health professional following your fall or accident, and the pain makes it difficult for you to walk, it is probably best to seek medical advice to be reassured.

***

Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !

You may also like:

• How Long Does it Take to Recover after Hip Fracture?
• Gamma Nail Treatment after Hip Fracture
• Mortality rate after hip fracture

 📚 SOURCES

Handoll  HHG, Sherrington  C, Mak  JCS. Interventions for improving mobility after hip fracture surgery in adults. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD001704. DOI: 10.1002/14651858.CD001704.pub4.

Dyer SM, Crotty M, Fairhall N, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016;16(1):158. Published 2016 Sep 2. doi:10.1186/s12877-016-0332-0

Verone et Maggi. Epidemiology and social costs of hip fracture. Injury. 2018 Volume 49, Issue 8, Pages 1458–1460