Hip fracture
A break in the upper femur, often from a fall.
A hip fracture is a break that occurs in the upper part of the femur, at the femoral neck or (rarely) the femoral head. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg; usually the person cannot walk. Hip fractures most often occur as a result of a fall, with risk factors including osteoporosis, taking many medications, alcohol use, and metastatic cancer.
- type
- Medical condition
- common_cause
- Fall
- risk_factors
- Osteoporosis, medications, alcohol, metastatic cancer
- diagnosis
- X-rays, MRI, CT scan, bone scan
- treatment
- Surgery (total hip replacement, hemiarthroplasty, screws), pain management
- demographics
- More common in women; 15% of women break a hip at some point
- mortality
- About 20% risk of death in the year following fracture in older people
Lore & Background
The classic clinical presentation of a hip fracture is an elderly patient who sustained a low-energy fall and now has groin pain and is unable to bear weight. Pain may be referred to the supracondylar knee. On examination, the affected extremity is often shortened and externally rotated compared to the unaffected leg. Displaced fractures of the trochanter or femoral neck will classically cause external rotation and shortening of the leg when the patient is laying supine.
Reader's Guide
Hip fractures are a significant medical event, particularly in the elderly, with about 15% of women breaking a hip at some point in life. The risk of death in the year following a fracture is about 20% in older people. Diagnosis is generally by X-rays, though MRI, CT scan, or bone scan may occasionally be required. Surgery is generally recommended within two days if the person's health allows, with options including total hip replacement, hemiarthroplasty, or stabilizing the fracture with screws. Complications are common and include nonunion, avascular necrosis of the femoral head (20% in intracapsular fractures), malunion, thromboembolism (fatal pulmonary embolism incidence about 2%), delirium, urinary tract infection, and pressure sores. Risk factors include osteoporosis, metabolic bone diseases, elevated homocysteine levels, metastatic cancer, and tobacco smoking. The biomechanics of a sideways fall significantly increase fracture risk, with a 15-fold increase in elderly males and 12-fold in females.
Did You Know?
- Hip fractures are usually femoral neck fractures.
- Avascular necrosis of the femoral head occurs frequently (20%) in intracapsular hip fractures.
- Fatal pulmonary embolism may have an incidence of 2% after hip fracture.
- During a sideways fall, the chances of hip fracture see a 15-fold and 12-fold increase in elderly males and females, respectively.
Frequently Asked Questions
What is a hip fracture?
A hip fracture is a break in the upper portion of the femur, most often at the femoral neck and less frequently at the femoral head. It typically presents with hip pain during movement, a visibly shortened leg, and an inability to walk or bear weight.
What most commonly causes a hip fracture?
The overwhelming majority of hip fractures result from a fall, particularly in individuals whose bones have been weakened by osteoporosis. Additional risk factors include long-term polypharmacy, heavy alcohol use, and metastatic cancer that has spread to the bone.
How is a hip fracture diagnosed?
Physicians usually begin with plain X-rays to visualize the break, and may follow up with an MRI, CT scan, or bone scan to pin down the exact location and severity of the fracture.
What treatment options exist for a hip fracture?
Most patients require surgery, which can range from screw fixation to hemiarthroplasty or a full total hip replacement depending on the fracture pattern. Aggressive pain management is a key component of both the immediate and post-operative recovery phases.
Who is at the highest risk of suffering a hip fracture?
Women are disproportionately affected, with roughly 15% of them expected to sustain a hip fracture at some point in their lives. The combination of age-related bone density loss, multiple medications, and lifestyle factors such as alcohol use compounds that risk.
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