Hip Fractures

Hip Fractures

 

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Defined as a condition in which the proximal end of the femur, pelvis or acetabulum is fractured.

-very serious injury in patients over the 65 years
-femoral fracture can take 3-6 months to heal
-high mortality rate long term disability and huge socio-economic burden
 -1.66 million
-Osteoporosis and cognitive impairment high risk factors
Relevant Anatomy:

-Femur

 -Femoral neck
 -Head of Femur
  -3/4 sphere
 -Greater trochanter
 -Lesser trochanter

-Acetabulum

 -Fusion of ilium, ischium, and pubis

-Convex head of femur fits into concave acetabulum
Fractures classification:

 -Intracapsular (37%): Contained within the hip capsule [neck fractures, femoral head]

   -Type 1: un-displaced and incomplete
-non-operative, partially weight bearing for 6 weeks
   -Type 2: un-displaced and complete fracture
    -operative or non-operative
   -Type 3: complete fx and partially displaced
    -surgical candidate
   -Type 4: complete fx and complete displaced
    -surgical candidate

 -Extracapsular (63%): Intertrochanteric and subtrochanteric fracture [Pelvic Ring- Ilium, ischium and pubis]
Risk factors:

 -Bone density
 -Low weight
 -Decrease muscle mass
 -70% females
 -Age > 70 y/o (90% of hip fractures)
 -Falls
 -Age, balance, stroke, Parkinson’s, decrease physical activity

Clinical Presentation:

 -Dull ache in pelvis/hip/groin
 -Decrease weight bearing, and movement
 -Shorter leg
 -Leg turns outward or external rotation
 -May or may not be swollen

Diagnosis:

-MRI gold standard
-X-rays are unreliable in early detection