The two most common injuries from a fall are hip injuries and wrist injuries. In this post, we’ll discuss hip injuries from a fall – how to approach someone who’s fallen, the most common types of injuries and whether your hip injury needs a x-ray.
Types of falls
Falls come in two varieties – there’s the trip & fall and the vertical fall.
A trip & fall is exactly as it sounds – you’re often walking or running along, you catch your toe and full forwards. Or you take a step to the side and lose your balance. Either way the fall tends to be limited in how hard you hit and has some horizontal motion (which reduces the impact).
The vertical fall can be a nasty one. The most common scenario is falling from a ladder while cleaning gutters or hanging out Christmas lights. These falls have more impact loading than a trip & fall and they’re likely to result in more severe injuries.
How to approach someone who’s had a fall
Regardless of which type of fall a person had, there are some key points on how you can approach and help them.
Firstly DON’T PICK THEM UP! Although it’s tempting to grab their arm and help them back up again, this can make injuries from a fall (like fractures and dislocations) much worse.
Start by talking to them, reassuring them and suggesting that they lay there for a moment to let the shock pass.
You can then ask them where they feel any pain – this is important to identify any concerns about spinal injuries. If they landed on their hip but their back or neck is sore, it’s always best to leave them on the ground and wait for an ambulance.
Once you know what area is sore, ask if they’re able to move it themselves (without any assistance). If they can’t move their leg, it’s best to leave them in place for a few minutes before trying again. If they still can’t move a few minutes later, wait for an ambulance.
If they can move the limb themselves, ask them to sit up and gradually move themselves into standing. You can offer an arm for them to hold on to but you should avoid pulling them into an upright position. Essentially they need to stand by themselves without being lifted there.
Once they’re in standing, take a moment and ask further about their symptoms. If they feel that the leg will hold their weight, they can try a short easy walk. Even if it’s painful, being able to complete a short walk is reassuring that the injury may not be major. It doesn’t rule out a fracture in the hip but it certainly makes it less likely.
Hip injuries from a fall
The injury to the hip depends on 2 things – whether there was direct impact to the back or side of the hip and whether the leg was twisted awkwardly during the fall.
Landing on the side of the hip
If the bony part of the hip (which you can feel on the side of the hip) impacts the ground directly, there are three injuries that into result. This can cause a fracture (most commonly in people over the age of 70), you can bruise the Gluteal tendon or it can bruise the soft tissue below the skin.
All 3 injuries can be very painful and cause more pain when the person tries to stand or walk. They’re also going to be painful to push on the side of the hip, so you can’t use tenderness on palpation to tell the difference between them.
The main way to check if there might be a fracture is to have the person relax and you move their leg for them. Only a small movement is required, like helping them move their leg sideways when they’re lying down. If it’s painful despite no help from their muscles, the bone may be injured (including bone bruises and fractures).
If the hip is still very painful 3-4 days later, or if the pain gets a lot worse with short walks, you should assume there might be a fracture until proven otherwise.
If there’s no pain to assist them moving the leg, and it begins to improve within a few days, it’s probably bruised tendon and soft tissue. It’s still a painful injury but it fully recovers in 4-6 weeks in most cases.
Landing on your bottom
Landing on your bum is actually a good way to fall. It’s got the most padding of any part of the body and is pretty robust.
The main injuries from a fall like this are wrist injuries (from sticking your hands out to break your fall) and lower back injuries (from the jolting impact). If there is any wrist or back pain associated with moving that area, it’s worth getting an X-ray (especially if they’re over 70 years old).
Most hip injuries from a fall on your bottom are muscle or soft tissue bruising injuries and they recover fully in 3-4 weeks. If the pain is still there after 4 weeks, you might have damaged a muscle in the fall, which takes around 6-8 weeks to recover.
Landing on your front
If you land forwards (like Superman), the hip is usually spared from any injuries.
You’ll graze your knees and injure your wrists from landing on outstretched hands, but the hip is typically OK.
Landing from height
Any fall from a height of more than 1 metre/meter (3 foot) is a concern, regardless of how you land.
Common injuries from a fall from height include head/neck injuries, spinal fractures, wrist and shoulder injuries and fractured hips. That risk goes up after the age of 50 and skyrockets once you’ve over the age of 70 years (it’s why falls prevention is so important for seniors).
For any fall from height, it’s recommended that you seek medical assistance. If you find someone on the ground after a fall from height, go through our checklist above before moving them.
When to get an Xray after a fall
There are a few key indicators to seek an Xray for hip injuries from a fall:
- Any fall from height – the risk of fractures goes up with falls from greater heights and in older age groups
- Unable to walk after the fall – if you’re unable to walk, you need an Xray ASAP
- Ongoing pain – if the pain is not improving after 3-5 days, it’s time for a medical assessment and an Xray
- Pain with movement at locations that weren’t impacted – if you landed on your hip but your lower back hurts, get an Xray
- Obvious deformity or malalignment – if the leg doesn’t look like it’s positioned normally, if it looks slightly longer or shorter than the other side or if it’s twisted inwards or outwards, this might be signs of hip fracture or dislocation