Hip fracture

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

Classification
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.
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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. Widely used classifications were established by Pauwels and Garden. 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.

Symptoms of Hip fracture
The list of signs and symptoms mentioned in various sources for Hip fracture includes the 3 symptoms listed below:
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Severe hip pain Hip swelling Inability to walk

Risk factors
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 deficiency is a common problem causing

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it reduced the amount of hip fractures by 80% after 2 years. Other metabolic bone diseases such as Paget's disease. Skeletal traction may be considered for long term treatment. Within 24 hours changes can be seen on MRI.y y y y y osteoporosis. This would normally include blood tests. Non-operative treatment is no longer an alternative in developed countries with modern health carecitation needed. This was despite no differences in bone density and in the number of falls between the vitamin and the placebo groups. standard treatment is fixation of the fracture in situ with screws or a sliding screw/plate device. Bone scan is less useful because it may take up to 1 week to demonstrate changes especially in the elderly. osteomalacia. Stress fractures may occur in the hip region with metabolic bone disease. Infection in the bone is a rare cause of hip fracture. Since prolonged immobilization can be more of a health risk than the surgery itself. This treatment can also be offered for displaced fractures after the fracture has been reduced. reduced by B-vitamins in this study[3]. For low-grade fractures (Garden types 1 and 2).[2] Homocysteine. a CT scan with 3D reconstruction may be helpful. a toxic 'natural' amino acid linked to the cause of heart disease. particularly in older people. Benign or malignant primary bone tumours are rare causes of hip fractures. Pain is significant. AP and lateral views should be obtained. Hip fractures are treated in one of two ways: Traction or orthopedic surgery. Management y y y Most hip fractures are treated by orthopedic surgery. The surgery is a major stress on the patient. stroke and bone fractures. and supplementing with vitamin D and calcium has been shown to reduce hip fractures by 43%. ECG and chest x-ray. Diagnosis y y y y X-rays of the affected hip usually make the diagnosis obvious. Aggressive chest physiotherapy is needed to reduce the risk of pneumonia and skilled nursing to try to avoid pressure sores and DVT/pulmonary embolism Most patients will be bedbound for several months. MRI has gained importance in the diagnosis of occult fractures of the femoral neck. In situations where a hip fracture is suspected but is not obvious on x-ray. . full pre-operative general investigation is required. forcing the patient to remain immobilized. 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. often with the assistance of physical therapy(physiotherapy). osteopetrosis and osteogenesis imperfecta. Metastatic cancer deposits in the proximal femur may weaken the bone and cause a pathological hip fracture. As the patients most often require an operation. which involves implanting an orthosis. post-op patients are encouraged to become mobile as soon as possible.

below the neck of the femur. but much more rare with other types of hip fracture. because the blood supply is interrupted. . The rate of nonunion is increased if the fracture is not treated surgically to immobilize the bone fragments. Treatment involves stabilizing the fracture with a lag screw and plate device to hold the two fragments in position. Only young patients tend to consider having it removed. A large screw is inserted into the femoral head. valgus deformity. healing of the fracture in a distorted position. and rotational malunion all occur often because the fracture may be unstable and collapse before it heals. The thigh muscles tend to pull on the bone fragments. has a good chance of healing. Hip fractures rarely results in neurological or vascular injury. 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.y y y In elderly patients with displaced fractures many surgeons prefer to undertake a Hemiarthroplasty. and replaces it with a prosthetic implant. following which the infection may clear up. is very common. Surgical y Deep or superficial wound infection has an approximate incidence of 2%. increasing the risk of a break if another accident occurs. Avascular necrosis of the femoral head occurs frequently (20%) in fractures of the neck of femur. the doctor completely removes the head and neck of the femur. Then the implant should be removed. It is a serious problem as superficial infection may lead to deep infection. The advantage is that the patient can mobilize without having to wait for healing. The fracture typically takes 3±6 months to heal. failure of the fracture to heal. causing them to overlap and reunite incorrectly. It is rare after intertrochanteric fractures. varus deformity. Bacteria inside the implants are inaccessible to the body's defence system and to antibiotics. This may not be as much of a concern in patients with limited independence and mobility. with smaller screws securing it in place. As it is only common in elderly. the implant may function as a stress riser. An intertrochanteric fracture. is common (20%) in fractures of the neck of the femur. crossing through the fracture. replacing the broken part of the bone with a metal implant. treatment of the osteoporosis can well reduce the risk of further fracture. the plate runs down the shaft of the femur. 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. The management is to attempt to suppress the infection with drainage and antibiotics until the bone is healed. Shortening. Hip replacement y y Main article: Hip replacement In some hip fractures. Complications y y y y Nonunion. if this is the case. Malunion. The most common cause for hip fractures in the elderly is osteoporosis.

and chest infection. does increase the risk of medical illness including heart attack. but the disorienting experience of pain. . commonly causing infection. Nevertheless. Mental confusion is extremely common following a hip fracture. moving to a strange place. This occurs either through inaccurate implant placement or if the fixation does not hold in weak and brittle bone. This may not be a severe problem or may require subsequent osteotomy surgery for correction. loss of independence. Fatal PE may have an incidence of 2% after hip fracture and may contribute to illness and mortality in other cases. Blood clots may result. Urinary tract infection (UTI) can occur. immobility. and drugs combine to cause delirium or accentuate pre-existing dementia. the stress of the injury. Circulation to parts of the lungs are cut off which can be very dangerous. or changed to a total hip replacement. DVT can occur without causing symptoms.y y Implant failure may occur. especially rotation. the metal screws and plate can break. alternating pressure mattresses should be used. Medical y y y y y Many of patients are unwell before breaking a hip. back out. and a likely surgery. especially in the elderly. Prolonged immobilization and difficulty moving make it hard to avoid pressure sores on the sacrum and heels of patients with hip fractures. Patients are immobilized and in bed for many days. stroke. Deep venous thrombosis (DVT) is when the blood in the leg veins clots and causes pain and swelling. they are frequently catheterised. Whenever possible. This is very common after hip fracture as the circulation is stagnant and the blood is hypercoagulable as a response to injury. A pulmonary embolism (PE) occurs when clotted blood from a DVT comes loose from the leg veins and passes up to the lungs. or cut out superiorly and enter the joint. Mal-positioning: The fracture can be fixed and subsequently heal in an incorrect position. In the event of failure. the surgery may be redone. otherwise. early mobilization is advocated. It usually clears completely. surgery. it is not uncommon for the break to have been caused by a fall due to some illness.