Hip fracture

Definition:

• A break in the proximal end of the femur, near the hip joint.

Epidemiology:

• Common in the elderly, especially in osteoporotic individuals.
• Increased incidence in females post-menopause due to decreased bone mineral density.

Types:

• Intracapsular: Fracture within the joint capsule (e.g., femoral neck fracture).
• Extracapsular: Fracture outside the joint capsule (e.g., intertrochanteric, subtrochanteric fractures).

Clinical Presentation:

• Pain in the groin or outer upper thigh.
• Unable to weight bear on the affected side.
• Affected leg may appear shortened and externally rotated.

Investigations:

• X-ray of the pelvis and hip: Anteroposterior (AP) and lateral views are standard.
• CT scan: If x-ray is inconclusive but high clinical suspicion remains.

Management:

• Analgesia: Often required to manage pain.
• Surgery: Depending on the type and location of fracture. Can be internal fixation, hemiarthroplasty, or total hip replacement.
• Multidisciplinary team input: Including physiotherapy for rehabilitation.

Complications:

• Deep vein thrombosis (DVT) and pulmonary embolism (PE).
• Pressure sores due to immobility.
• Infection, especially if surgical intervention was involved.
• Non-union or malunion of the fracture.
• Avascular necrosis: Particularly in intracapsular fractures.

Prognosis:

• Depends on patient’s age, general health, type of fracture, and timeliness of treatment.
• Mortality rate can be significant in the elderly, especially if surgery is delayed.