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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.

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