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.
