Hip fracture
Encyclopedia
A hip fracture is a femoral fracture
that occurs in the proximal end of the femur
(the long bone running through the thigh
), near the hip.
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 accident
s.
In the UK, the mortality following a fractured neck of femur is between 20% and 35% within one year in patients aged 82, ± 7 years, of which 80% were women.
. The most common causes of weakness in bone are:
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.
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.
Hip fractures are treated in one of two ways: Traction
or orthopedic surgery
.
, which involves implanting an orthosis. The surgery is a major stress on the patient, particularly in older people. Pain is significant, forcing the patient to remain immobilized. Since prolonged immobilization can be more of a health risk than the surgery itself, post-op patients are encouraged to become mobile as soon as possible, often with the assistance of rehabilitation professionals such as occupational therapy
and physical therapy
(physiotherapy).
If operative treatment is refused or the risks of surgery are considered to be too high the main emphasis of treatment is on pain relief. Skeletal traction
may be considered for long term treatment. Aggressive chest physiotherapy is needed to reduce the risk of pneumonia
and skilled rehabilitation and nursing to avoid pressure sores and DVT
/pulmonary embolism
Most patients will be bedbound for several months. Non-operative treatment is no longer an alternative in developed countries with modern health care.
For low-grade fractures (Garden types 1 and 2), standard treatment is fixation of the fracture in situ with screws or a sliding screw/plate device. This treatment can also be offered for displaced fractures after the fracture has been reduced.
In elderly patients with displaced or intracapsular fractures many surgeons prefer to undertake a hemiarthroplasty, replacing the broken part of the bone with a metal implant. The advantage is that the patient can mobilize without having to wait for healing.
Traction is contraindicated in femoral neck fractures due to it affecting blood flow to the head of the femur.
An intertrochanteric fracture, below the neck of the femur, has a good chance of healing. Treatment involves stabilizing the fracture with a lag screw and plate device to hold the two fragments in position. A large screw is inserted into the femoral head, crossing through the fracture; the plate runs down the shaft of the femur, with smaller screws securing it in place.
The fracture typically takes 3–6 months to heal. As it is only common in elderly, removal of the dynamic hip screw
is usually not recommended to avoid unnecessary risk of second operation and the increased risk of re-fracture after implant removal. The most common cause for hip fractures in the elderly is osteoporosis; if this is the case, treatment of the osteoporosis can well reduce the risk of further fracture. Only young patients tend to consider having it removed; the implant may function as a stress riser, increasing the risk of a break if another accident occurs.
, failure of the fracture to heal, is common (20%) in fractures of the neck of the femur, but much more rare with other types of hip fracture. The rate of nonunion is increased if the fracture is not treated surgically to immobilize the bone fragments.
Malunion, healing of the fracture in a distorted position, is very common. The thigh muscles tend to pull on the bone fragments, causing them to overlap and reunite incorrectly. Shortening, varus deformity
, valgus deformity
, and rotational malunion all occur often because the fracture may be unstable and collapse before it heals. This may not be as much of a concern in patients with limited independence and mobility.
Avascular necrosis
of the femoral head occurs frequently (20%) in fractures of the neck of femur, because the blood supply is interrupted. It is rare after intertrochanteric fractures.
Hip fractures rarely result in neurological or vascular
injury.
Implant failure may occur; the metal screws and plate can break, back out, or cut out superiorly and enter the joint. This occurs either through inaccurate implant placement or if the fixation does not hold in weak and brittle bone. In the event of failure, the surgery may be redone, or changed to a total hip replacement.
Mal-positioning: The fracture can be fixed and subsequently heal in an incorrect position; especially rotation. This may not be a severe problem or may require subsequent osteotomy
surgery for correction.
due to some illness, especially in the elderly. Nevertheless, the stress of the injury, and a likely surgery, does increase the risk of medical illness including heart attack
, stroke, and chest infection
.
Blood clots
may result. Deep venous thrombosis (DVT) is when the blood in the leg veins clots and causes pain and swelling. This is very common after hip fracture as the circulation is stagnant and the blood is hypercoagulable as a response to injury. DVT can occur without causing symptoms. A pulmonary embolism
(PE) occurs when clotted blood from a DVT comes loose from the leg veins and passes up to the lungs. Circulation to parts of the lungs are cut off which can be very dangerous. Fatal PE may have an incidence of 2% after hip fracture and may contribute to illness and mortality in other cases.
Mental confusion
is extremely common following a hip fracture. It usually clears completely, but the disorienting experience of pain, immobility, loss of independence, moving to a strange place, surgery, and drugs combine to cause delirium
or accentuate pre-existing dementia
.
Urinary tract infection
(UTI) can occur. Patients are immobilized and in bed for many days; they are frequently catheterised
, commonly causing infection.
Prolonged immobilization and difficulty moving make it hard to avoid pressure sores on the sacrum and heels of patients with hip fractures. Whenever possible, early mobilization is advocated; otherwise, alternating pressure mattresses should be used.
are all increased by immobility. The prognosis of untreated hip fractures is very poor.
s; most of those affected require some sort of living assistance from family or home-care providers. 50% permanently require walker
s, canes, or cruches for mobility; all require some sort of mobility assistance throughout the healing process.
Among those affected over the age of 50, approximately 25% die within the next year due to complications such as blood clots
(deep venous thrombosis, pulmonary embolism
), infection
s, and pneumonia
.
Patients with hip fractures are at high risk for future fractures including hip, wrist, shoulder, and spine. After treatment of the acute fracture, the risk of future fractures should be addressed. Currently, only 1 in 4 patients after a hip fracture receives treatment and work up for osteoporosis the underlying cause of most of the fractures. Current treatment standards include the starting of a bisphosphonate
to reduce future fracture risk by up to 50%.
Femoral fracture
A femoral fracture is a bone fracture that involves the femur. It includes hip fractures.-Classification:A femoral fracture that involves the femoral head, femoral neck or the shaft of the femur immediately below the lesser trochanter may be classified as a hip fracture, especially when associated...
that occurs in the proximal end of the femur
Femur
The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
(the long bone running through the thigh
Thigh
In humans the thigh is the area between the pelvis and the knee. Anatomically, it is part of the lower limb.The single bone in the thigh is called the femur...
), near the hip.
The term "hip fracture" is commonly used to refer to four different fracture patterns and is often due to osteoporosis
Osteoporosis
Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
; 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
Osteoporosis
Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
bone. Most hip fractures in people with normal bone are the result of high-energy trauma such as car accident
Car accident
A traffic collision, also known as a traffic accident, motor vehicle collision, motor vehicle accident, car accident, automobile accident, Road Traffic Collision or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other stationary obstruction,...
s.
In the UK, the mortality following a fractured neck of femur is between 20% and 35% within one year in patients aged 82, ± 7 years, of which 80% were women.
- Femoral head fracture denotes a fracture involving the femoral head. This is usually the result of high energy trauma and a dislocation of the hip joint often accompanies this fracture.
- Femoral neck fracture (sometimes Neck of Femur (NOF), subcapital, or intracapsular fracture)
- Subtrochanteric fracture actually involves the shaft of the femurFemurThe femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
immediately below the lesser trochanter and may extend down the shaft of the femur.
Signs and symptoms
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 unnaturally, externally rotated compared to the unaffected leg.Risk factors
Hip fracture following a fall is likely to be a pathological fracturePathologic fracture
A pathologic fracture is a broken bone caused by disease leading to weakness of the bone. This process is most commonly due to osteoporosis, but may also be due to other pathologies such as: cancer, infection, inherited bone disorders,or a bone cyst...
. The most common causes of weakness in bone are:
- OsteoporosisOsteoporosisOsteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
. - HomocysteineHomocysteineHomocysteine is a non-protein amino acid with the formula HSCH2CH2CHCO2H. It is a homologue of the amino acid cysteine, differing by an additional methylene group. It is biosynthesized from methionine by the removal of its terminal Cε methyl group...
, a toxic 'natural' amino acid linked to the cause of heart diseaseHeart diseaseHeart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
, - Other metabolic bone diseases such as Paget's diseasePaget's diseaseSir James Paget, a surgeon and pathologist, described several diseases, including:* Paget's disease of bone * Paget's disease of the breast* Paget-Schroetter disease* Extramammary Paget's disease...
, osteomalaciaOsteomalaciaOsteomalacia is the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium, or because of overactive resorption of calcium from the bone as a result of hyperparathyroidism...
, osteopetrosisOsteopetrosisOsteopetrosis, literally "stone bone", also known as marble bone disease and Albers-Schonberg disease is an extremely rare inherited disorder whereby the bones harden, becoming denser, in contrast to more prevalent conditions like osteoporosis, in which the bones become less dense and more brittle,...
and osteogenesis imperfectaOsteogenesis imperfectaOsteogenesis imperfecta is a genetic bone disorder. People with OI are born with defective connective tissue, or without the ability to make it, usually because of a deficiency of Type-I collagen...
. Stress fractureStress fractureA stress fracture is one type of incomplete fracture in bones. It is caused by "unusual or repeated stress" and also heavy continuous weight on the ankle or leg...
s may occur in the hip region with metabolic bone disease. - Benign or malignant primary bone tumoursBone tumorA bone tumor refers to a neoplastic growth of tissue in bone. Abnormal growths found in the bone can be either benign or malignant .-Classification:...
are rare causes of hip fractures. - MetastaticMetastasisMetastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
cancer deposits in the proximal femur may weaken the bone and cause a pathological hip fracture. - InfectionOsteomyelitisOsteomyelitis simply means an infection of the bone or bone marrow...
in the bone is a rare cause of hip fracture.
Diagnosis
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
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:
- Type 1 is a stable fracture with impaction in valgus.
- Type 2 is complete but non-displaced.
- Type 3 is displaced (often rotated and angulated) with varus displacement but still has some contact between the two fragments.
- Type 4 is completely displaced and there is no contact between the fracture fragments.
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
Arthroplasty
Arthroplasty is an operative procedure of orthopedic surgery performed, in which the arthritic or dysfunctional joint surface is replaced with something better or by remodeling or realigning the joint by osteotomy or some other procedure.-Background:Previously, a popular form of arthroplasty was...
. 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
Avascular necrosis
Avascular necrosis is a disease where there is cellular death of bone components due to interruption of the blood supply. Without blood, the bone tissue dies and the bone collapses...
. 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
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.Hip fractures are treated in one of two ways: Traction
Traction (orthopedics)
In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system.There are two types of traction: skin traction and skeletal traction....
or orthopedic surgery
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...
.
Management
Most hip fractures are treated by orthopedic surgeryOrthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...
, which involves implanting an orthosis. The surgery is a major stress on the patient, particularly in older people. Pain is significant, forcing the patient to remain immobilized. Since prolonged immobilization can be more of a health risk than the surgery itself, post-op patients are encouraged to become mobile as soon as possible, often with the assistance of rehabilitation professionals such as occupational therapy
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
and physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
(physiotherapy).
If operative treatment is refused or the risks of surgery are considered to be too high the main emphasis of treatment is on pain relief. Skeletal traction
Traction (orthopedics)
In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system.There are two types of traction: skin traction and skeletal traction....
may be considered for long term treatment. Aggressive chest physiotherapy is needed to reduce the risk of pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
and skilled rehabilitation and nursing to avoid pressure sores and DVT
Deep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
/pulmonary embolism
Pulmonary embolism
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
Most patients will be bedbound for several months. Non-operative treatment is no longer an alternative in developed countries with modern health care.
Fractured neck of femur
In elderly patients with displaced or intracapsular fractures many surgeons prefer to undertake a hemiarthroplasty, replacing the broken part of the bone with a metal implant. The advantage is that the patient can mobilize without having to wait for healing.
Traction is contraindicated in femoral neck fractures due to it affecting blood flow to the head of the femur.
Intertrochanteric fracture
The fracture typically takes 3–6 months to heal. As it is only common in elderly, removal of the dynamic hip screw
Dynamic hip screw
Dynamic hip screw or Sliding Screw Fixation is a type of orthopaedic implant designed for fixation of certain types of intertrochanteric and subtrochanteric fractures which allows controlled dynamic sliding of the femoral head component along the construct...
is usually not recommended to avoid unnecessary risk of second operation and the increased risk of re-fracture after implant removal. The most common cause for hip fractures in the elderly is osteoporosis; if this is the case, treatment of the osteoporosis can well reduce the risk of further fracture. Only young patients tend to consider having it removed; the implant may function as a stress riser, increasing the risk of a break if another accident occurs.
Hip replacement
In some hip fractures, the doctor completely removes the head and neck of the femur, and replaces it with a prosthetic implant.Complications
NonunionNonunion
Nonunion is permanent failure of healing following a broken bone.Nonunion is a serious complication of a fracture and may occur when the fracture moves too much, has a poor blood supply or gets infected. Patients who smoke have a higher incidence of nonunion. The normal process of bone healing is...
, failure of the fracture to heal, is common (20%) in fractures of the neck of the femur, but much more rare with other types of hip fracture. The rate of nonunion is increased if the fracture is not treated surgically to immobilize the bone fragments.
Malunion, healing of the fracture in a distorted position, is very common. The thigh muscles tend to pull on the bone fragments, causing them to overlap and reunite incorrectly. Shortening, varus deformity
Varus deformity
In orthopedics, a varus deformity is a term for the inward angulation of the distal segment of a bone or joint. The opposite of varus is called valgus.The terms varus and valgus always refer to the direction that the distal segment of the joint points....
, valgus deformity
Valgus deformity
In orthopedics, a valgus deformity is a term for outward angulation of the distal segment of a bone or joint. The opposite deformation, medial deviation of the distal bone, is called varus....
, and rotational malunion all occur often because the fracture may be unstable and collapse before it heals. This may not be as much of a concern in patients with limited independence and mobility.
Avascular necrosis
Avascular necrosis
Avascular necrosis is a disease where there is cellular death of bone components due to interruption of the blood supply. Without blood, the bone tissue dies and the bone collapses...
of the femoral head occurs frequently (20%) in fractures of the neck of femur, because the blood supply is interrupted. It is rare after intertrochanteric fractures.
Hip fractures rarely result in neurological or vascular
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
injury.
Surgical
Deep or superficial wound infection has an approximate incidence of 2%. It is a serious problem as superficial infection may lead to deep infection. This may cause infection of the healing bone and contamination of the implants. It is difficult to eliminate infection in the presence of metal foreign bodies such as implants. Bacteria inside the implants are inaccessible to the body's defence system and to antibiotics. The management is to attempt to suppress the infection with drainage and antibiotics until the bone is healed. Then the implant should be removed, following which the infection may clear up.Implant failure may occur; the metal screws and plate can break, back out, or cut out superiorly and enter the joint. This occurs either through inaccurate implant placement or if the fixation does not hold in weak and brittle bone. In the event of failure, the surgery may be redone, or changed to a total hip replacement.
Mal-positioning: The fracture can be fixed and subsequently heal in an incorrect position; especially rotation. This may not be a severe problem or may require subsequent osteotomy
Osteotomy
An osteotomy is a surgical operation whereby a bone is cut to shorten, lengthen, or change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is also used to correct a coxa vara, genu valgum, and genu varum...
surgery for correction.
Medical
Many of patients are unwell before breaking a hip; it is not uncommon for the break to have been caused by a fallFalling (accident)
Falling is a major cause of personal injury, especially for the elderly. Builders, electricians, miners, and painters represent worker categories representing high rates of fall injuries. The WHO estimate that 392,000 people die in falls every year...
due to some illness, especially in the elderly. Nevertheless, the stress of the injury, and a likely surgery, does increase the risk of medical illness including heart attack
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
, stroke, and chest infection
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
.
Blood clots
Thrombus
A thrombus , or blood clot, is the final product of the blood coagulation step in hemostasis. It is achieved via the aggregation of platelets that form a platelet plug, and the activation of the humoral coagulation system...
may result. Deep venous thrombosis (DVT) is when the blood in the leg veins clots and causes pain and swelling. This is very common after hip fracture as the circulation is stagnant and the blood is hypercoagulable as a response to injury. DVT can occur without causing symptoms. A pulmonary embolism
Pulmonary embolism
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
(PE) occurs when clotted blood from a DVT comes loose from the leg veins and passes up to the lungs. Circulation to parts of the lungs are cut off which can be very dangerous. Fatal PE may have an incidence of 2% after hip fracture and may contribute to illness and mortality in other cases.
Mental confusion
Mental confusion
Confusion of a pathological degree usually refers to loss of orientation sometimes accompanied by disordered consciousness and often memory Confusion (from Latin confusĭo, -ōnis, noun of action from confundere "to pour together", also "to confuse") of a pathological degree usually refers to loss...
is extremely common following a hip fracture. It usually clears completely, but the disorienting experience of pain, immobility, loss of independence, moving to a strange place, surgery, and drugs combine to cause delirium
Delirium
Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...
or accentuate pre-existing dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
.
Urinary tract infection
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
(UTI) can occur. Patients are immobilized and in bed for many days; they are frequently catheterised
Urinary catheterization
In urinary catheterization , a latex, polyurethane or silicone tube known as a urinary catheter is inserted into a patient's bladder via his or her urethra. Catheterization allows the patient's urine to drain freely from the bladder for collection. It may be used to inject liquids used for...
, commonly causing infection.
Prolonged immobilization and difficulty moving make it hard to avoid pressure sores on the sacrum and heels of patients with hip fractures. Whenever possible, early mobilization is advocated; otherwise, alternating pressure mattresses should be used.
Prognosis
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 infectionsPneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
are all increased by immobility. The prognosis of untreated hip fractures is very poor.
Post operation
Among those affected over the age of 65, 40% are transferred directly to long-term care facilities, long-term rehabilition facilities, or nursing homeNursing home
A nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...
s; most of those affected require some sort of living assistance from family or home-care providers. 50% permanently require walker
Walker (tool)
A walker or walking frame is a tool for disabled or elderly people who need additional support to maintain balance or stability while walking...
s, canes, or cruches for mobility; all require some sort of mobility assistance throughout the healing process.
Among those affected over the age of 50, approximately 25% die within the next year due to complications such as blood clots
Thrombus
A thrombus , or blood clot, is the final product of the blood coagulation step in hemostasis. It is achieved via the aggregation of platelets that form a platelet plug, and the activation of the humoral coagulation system...
(deep venous thrombosis, pulmonary embolism
Pulmonary embolism
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
), infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
s, and pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
.
Patients with hip fractures are at high risk for future fractures including hip, wrist, shoulder, and spine. After treatment of the acute fracture, the risk of future fractures should be addressed. Currently, only 1 in 4 patients after a hip fracture receives treatment and work up for osteoporosis the underlying cause of most of the fractures. Current treatment standards include the starting of a bisphosphonate
Bisphosphonate
Bisphosphonates are a class of drugs that prevent the loss of bone mass, used to treat osteoporosis and similar diseases...
to reduce future fracture risk by up to 50%.
Epidemiology
Approximately 320,000 hospitalizations occur each year due to hip fractures in the US.External links
- Orthopedics.com article on hip fractures
- Fractures of the Femoral Neck Wheeless Textbook of Orthopaedics
- Intertrochanteric Fractures Wheeless' Textbook of Orthopaedics
- National Hip Fracture Database National Hip Fracture Database
- Proximal femoral fracture Musculoskeletal Radiology of Fractures
- National Osteoporosis Society National Osteoporosis Society