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Hip fracture
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AP Hip projection demonstrating an Intertrochanteric fracture

Hip fracture
Classification and external
resources

ICD-10 S72.0

ICD-9 820

A hip fracture is a fracture in the proximal end of the femur (the long bone running
through the thigh), near the hip joint.

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.
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.[1]

Contents
[hide]

• 1 Types
• 2 Incidence
o 2.1 Pathogenesis/risk factors
• 3 Natural history
• 4 Clinical features
o 4.1 Investigations
o 4.2 Femoral neck fracture
o 4.3 Intertrochanteric fracture
• 5 See also
• 6 References

• 7 External links

[edit] Types
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.

• 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) denotes a fracture adjacent to the femoral head in the neck
between the head and the greater trochanter. These fractures have a propensity to
damage the blood supply to the femoral head, potentially causing avascular
necrosis.
• Intertrochanteric fracture denotes a break in which the fracture line is between
the greater and lesser trochanter on the intertrochanteric line. It is the most
common type of 'hip fracture' and prognosis for bony healing is generally good if
the patient is otherwise healthy.
• Subtrochanteric fracture actually involves the shaft of the femur immediately
below the lesser trochanter and may extend down the shaft of the femur.

[edit] Incidence
Approximately 320,000 hospitalizations occur each year due to hip fractures in the US.[2]

[edit] Pathogenesis/risk factors

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 causes of weakness in bone are:

• Osteoporosis. Hip fractures are one of the most serious complications of

osteoporosis; in fact a measure of success or failure of treatment of osteoporosis is
the proportion of patients who sustain a hip fracture. Vitamin D deficieny is a
common problem causing osteoporosis, and supplementing with vitamin D and
calcium has been shown to reduce hip fractures by 43%.[[1]].
• Homocysteine, a toxic 'natural' amino acid linked to the cause of heart disease,
stroke and bone fractures, reduced by B-vitamins in this study [2], it reduced the
amount of hip fractures by 80% after 2 years. This was despite no differences in
bone density and in the number of falls between the vitamin and the placebo
groups.
• Other metabolic bone diseases such as Paget's disease, osteomalacia, osteopetrosis
and osteogenesis imperfecta. Stress fractures may occur in the hip region with
metabolic bone disease.
• Benign or malignant primary bone tumours are rare causes of hip fractures.
• Metastatic cancer deposits in the proximal femur may weaken the bone and cause
a pathological hip fracture.
• Infection in the bone is a rare cause of hip fracture.

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.

[edit] Natural history

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.
[edit] Clinical features
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.

[edit] Investigations

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.

[edit] 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:

• 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.
 Garden Type 1 Fractured Neck of Femur

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.

[edit] Intertrochanteric fracture

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.

[edit] See also

• Hip fracture treatment

[edit] References
1. ^ Mortality after admission to hospital with fractured neck of femur: database
study
2. ^ American Academy of Orthopedic Surgeons article on hip fractures

[edit] External links

Wikimedia Commons has media related to:

Hip fractures
 • Orthopedics.com article on hip fractures
• Fractures of the Femoral Neck Wheeless Textbook of Orthopaedics
• Intertrochanteric Fractures Wheeless' Textbook of Orthopaedics
• Proximal femoral fracture Musculoskeletal Radiology of Fractures
• Hip fractures
• Urbandale Family Physicians - Franny

[hide]
v•d•e
Fractures (Sx2, 800-829)

Avulsion fracture · Greenstick fracture · Salter-Harris

General
fractures

Head Skull fracture · Basilar · Blowout

Cervical · Jefferson · Hangman's · Flexion teardrop ·

Vertebral Extension teardrop, Clay-shoveler · Burst · Compression ·
Wedge · Chance · Hyperextension fracture dislocation

Ribs Rib fracture · Flail chest · Sternal

Clavicle · Humerus · Monteggia · Galeazzi · Colles' ·

Shoulder, arm and hand Smith's · Barton's · Scaphoid · Rolando · Bennett's ·
Boxer's . Distal Radius · Scapular

Hip fracture · Segond · trimalleolar · Bimalleolar · Pott's ·

Hip, leg and foot
Maisonneuve · Lisfranc · Calcaneal · Jones fracture
Retrieved from "http://en.wikipedia.org/wiki/Hip_fracture"
Categories: Bone fractures

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