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The term "hip fracture" is commonly used to refer to four different fracture patterns and is often due to osteoporosis; in the vast majority of cases, a hip fracture is a fragility fracture due to a fall or minor trauma in someone with weakened osteoporotic bone. Most hip fractures in people with normal bone are the result of high-energy trauma such as car accidents.
The mortality following a hip fracture is between 20% and 35% within one year in patients aged 82 ± 7 years old, of which 80% were women.
Many subtypes of fractures about the hip joint are colloquially known as 'hip fractures'. Although a true hip fracture involves the joint, the following four proximal femur fractures are commonly referred to as 'hip fractures'. The differences between them are important because each is treated differently.
Approximately 320,000 hospitalizations occur each year due to hip fractures in the US.
Most hip fractures occur as a result of low-energy falls in elderly patients. Falls are uncommon in young adults due to better balance and strength and when they do occur, they usually do not cause the "hip fracture" pattern of injury that is commonly seen in the elderly. It was formerly thought, but Harvard medical scientists disproved, that benzodiazepine use increased the risk. A person with normal hips will not fracture following a fall from standing. Hip fracture following a fall is likely to be a pathological fracture. The most common cause of weakness in bone is
Another element in the risk of sustaining a hip fracture is the risk of falling. Fall prevention is an area if interest with concerns in the area of providing a safe environment for people at risk, custodial care, walking aids, medication issues etc. Hip protectors are padded plastic shields that can be placed over the trochanters of people at risk of falling or of sustaining a fragility fracture. However, they are not effective in reducing the likelihood of a hip fracture and compliance is poor.
Hip fractures are very dangerous episodes especially for elderly and frail patients. The risk of dying from the stress of the surgery and the injury in the first few days is about 10%. If the condition is untreated the pain and immobility imposed on the patient increase that risk. Problems such as pressure sores and chest infections are all increased by immobility. The prognosis of untreated hip fractures is very poor.
The classic clinical presentation of a hip fracture is an elderly patient who sustained a low-energy fall and now has pain and is unable to bear weight. On examination, the affected extremity is often shortened and externally rotated.
X-rays of the affected hip usually make the diagnosis obvious; AP and lateral views should be obtained.
In situations where a hip fracture is suspected but is not obvious on x-ray, a CT scan with 3D reconstruction may be helpful. MRI has gained importance in the diagnosis of occult fractures of the femoral neck. Within 24 hours changes can be seen on MRI. Bone scan is less useful because it may take up to 1 week to demonstrate changes especially in the elderly.
As the patients most often require an operation, full pre-operative general investigation is required. This would normally include blood tests, ECG and chest x-ray.
Femoral neck fracture
Femoral neck fractures involve the narrow neck between the round head of the femur and the shaft. This fracture often disrupts the blood supply to the head of the femur.
Garden classified this fracture into four types:
The blood supply of the femoral head is much more likely to be disrupted in Garden types 3 or 4 fractures.
Surgeons may treat these types of fracture by replacing the fractured bone with a prosthesis arthroplasty. Alternatively the treatment is to reduce the fracture (manipulate the fragments back into a good position) and fix them in place with three metal screws.
A serious but common complication of a fractured femoral neck is avascular necrosis. The vasculature to the femoral head is easily disturbed during fractures or from swelling inside the joint capsule. This can lead to strangulation of the blood supply to the femoral head and death of the bone and cartilage.
Intertrochanteric fractures occur between the greater and lesser trochanters. They are usually fixed with a sliding hip screw and plate. Healing is usually good when the patient is healthy.
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Hip_fracture". A list of authors is available in Wikipedia.|