Hip Fracture



Patient Story





A 60-year-old woman comes to the emergency room for hip pain. She felt a pop in her hip accompanied by the immediate onset of pain that prohibited her from walking. She had fallen 2 days prior. Figure 105-1 shows a transcervical left femoral neck fracture with varus angulation and superior offset of the distal fracture fragment. She was evaluated by an orthopedic surgeon and underwent surgery the next day (Figure 105-2). After many months of rehabilitation, she was able to walk again.







Figure 105-1



Transcervical left femoral neck fracture with varus angulation and superior offset of the distal fracture fragment. The femoral head is within the acetabular cup. Degenerative changes of the left hip are also present. (Courtesy of John E. Delzell, Jr., MD.)








Figure 105-2



Postsurgical portable radiograph demonstrating good positioning of artificial hip. (Courtesy of John E. Delzell, Jr., MD.)







Epidemiology






  • Approximately 300,000 hip fractures per year occur in the United States.1
  • Seventy percent to 80% of hip fractures occur in women.1
  • Average age is 70 to 80 years; risk increases with age.1
  • Half of the patients with a hip fracture have osteoporosis.2






Etiology and Pathophysiology






  • Approximately 95% of hip fractures are caused by a fall.






Risk Factors






  • Low body mass index (BMI) and low physical activity in postmenopausal women.3
  • Low physical activity.3






Long-term use of proton pump inhibitor (PPI) is associated with increased risk of any fracture, including hip fracture.4






Diagnosis





Clinical Features: History and Physical




  • In a population study, major risk factors for hip fracture include:

    • Low bone mineral density (3.6-fold [95% confidence interval (CI), 2.6 to 4.5] in women and 3.4-fold [95% CI, 2.5 to 4.6] in men for each standard deviation [SD] [0.12 g/cm2] reduction in bone mineral density).5
    • Postural instability and/or quadriceps weakness.
    • A history of falls.
    • Prior hip fracture.5
    • Other factors associated with increased risk include: dementia, tobacco use, physical inactivity, impaired vision, and alcohol use.



Physical examination—Abducted and externally rotated hip; limp or refusal to walk.






Typical Distribution






  • Hip fractures are classified according to anatomic location.6




Jun 5, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Hip Fracture

Full access? Get Clinical Tree

Get Clinical Tree app for offline access