Hip fracture is among the most common injuries necessitating hospital admission. A hip fracture is a fracture in the proximal end of the femur (the long bone running through the thigh), near the hip joint. Proximal femoral fractures include a broad group of common fractures of the femoral head and neck typically occurring in osteoporotic females. Proximal femoral fracture is a common injury in elderly people with a current mortality at six months in females of 16% and in males of 43%. Hip fractures are very dangerous episodes especially for elderly and frail patients. Mortality with these fractures can approach 20 % in the elderly. Two groups are commonly discussed: intracapsular and extracapsular fractures. Extracapsular fractures include intertrochanteric and subtrochanteric fractures.
The intracapsular fractures embrace fractures of the femoral neck and head with capital, subcapital, transcervical, and basicervical varieties. The subcapital fracture is the most common of the four. The basicervical fractures include fractures farthest from the fovea. Intracapsular fractures have a high incidence of avascular necrosis of the femoral head (up to 35%). 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. 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.
Treatment options for subtrochanteric fractures include nonoperative and operative methods. The goal of treatment is fracture reduction so that near anatomic alignment and normal femoral anteversion are obtained. Most hip fractures are treated by orthopedic surgery, which involves implanting an orthosis. The surgery is a major stress on the patient, particularly in older people.Operative treatment allows for immediate mobilization and pain management and decreases the risk of complications such as skin breakdown, DVT, and pulmonary abnormalities. A few patients (eg, those who were not ambulatory before the event for reasons unrelated to the affected joint) are candidates for nonsurgical management. Rehabilitation is an important aspect of care.
Proximal Femur Fractures Treatment and Prevention Tips
1. Skeletal traction may be considered for long term treatment.
2. Aggressive chest physiotherapy is needed to reduce the risk of pneumonia.
3. Most hip fractures are treated by orthopedic surgery, which involves implanting an orthosis.