1 2

(hip joint)
(ball and socket joint)

(acetabulum)(femoral head)

(hip fracture)

1995 (femoral neck)

2001 (lesser trochanter)5

8 . 2 x 1 0 -4 6 5 (femoral shaft)(

7.56x10 -3 (74.114.9 ) )(pubic bone)

(66.819.0 )
1/5 (deep femoral
(m o r b i d i t y artery)(medial and
and mortality) lateral circumflex femoral artery)
15- (intracapsular)
20%
(ligment of femoral head)
(acetabular branch of obturator
artery)

(retinacular artery)

(intracapsular fracturefemoral
neck fracture)
1
2
hip fracture, femoral neck fracture, elderly fall (extracapsular fractureintertrochanteric
and subtrochanteric fracture) (

364


: 1

) (avascular necrosis)
Garden()
(nonunion
(femoral neck fracture) or malunion)
(intertrochanteric fracture)

45%;
1:3

45%;
1:3

10%; 20-40
60

: 2

365


Garden
: (valgus impaction of the femoral head)

: (complete but nondisplaced fracture)

: (varus displacement of the femoral head)

: (complete loss of continuity between both fragments)

: 2

(stable
impacted fractures or nondisplaced
(subtrochanteric fractures)
fracture)

X
X()

MRICT

bone scanMRI()
(shortening,

a b d u c t i o n a n d e x t e r n a l r o t a t i o n )
MRIbone

scanCTMRI
(limited range of
bone scan X
motion)
98%

MRI100%

72bone

scan

366


X MRI

: 75X : MRI

: 2
2

(2)
(low molecular weight heparin)

(thrombocytopenia)
(3)(low dose
7512g/ unfractionated heparin)(4)warfarin
dl(peritrochanteric
fracture) INR(2.5)

(deep vein
thrombosis and pulmonary embolism) Aspirin

(thromboprophylaxis)
(1)fondaparinux -
F D A
ACCP(American College fo Chest
Physicians) (pneumatic sequential
leg compression device)

367


(graduated
compression stockings) 48

2 72
24
(Staphylococcus aureus)

(cephalosporin)

(vancomycin)
(delirium)

1.

(surgical

reduction and internal fixation)

(percutaneous pinning)

(compression hip screw or dynamic
24
hip screw

(anticholinergics)

(sedatives)
(hemiarthroplasty)

meperidine(Demerol)

2.

368


(intramedullary nail)

3.

(interlocking screws)(plate)

1. Miller RR, Christmas C, Magaziner J: Hip

fractures. In: Halter JB, Ouslander JG, Tinetti

ME, et al, eds. Hazzards Geriatric Medicine and

Gerontology. 6th ed. New York: McGraw-Hill,

2009: 1435-44.

2. Brunner LC, Eshilian-Oates L, Kuo TY: Hip

fractures in adults. Am Fam Physician 2003; 67:

(conservative 537-42.
treatment) 3. Ra o SS, C he ruk uri M: M a na ge me nt o f hi p
fracture: the family physician's role. Am Fam
Physician 2006; 73: 2195-200.
4. National Clinical Guideline Centre (UK): The

(2 Management of Hip Fracture in Adults [Internet].

) NICE Clinical Guidelines 2011; 124.

5. American Academy of Orthopaedic Surgeons:

Hip fractures. (http://orthoinfo.aaos.org/topic.

cfm?topic=A00392, latest accessed on April 11,

2012)

6. Burroughs KE, Walker KM: Hip fractures in

adults. UpToDate. 2012.

7. Morrison RS, Siu AL: Medical consultation for
patients with hip fracture. UpToDate. 2012.
8.
2005929-38

369