Hip fracture general

• Peak incidence: > 70 years [1]

• Sex: ♀ > ♂ [1]

Mechanism of injury [2]

• Older adults

  • Fall onto greater trochanter/lateral hip

  • Forced lateral rotation (e.g., from tripping)

  • Chronic overburdening can lead to insufficiency fractures, which can then completely fracture spontaneously.

  • Pathological fracture due to metastases

• Children and young adults: high-s

• Osteoporosis (especially postmenopausal women and older individuals)

• Muscle weakness

• Difficulty walking and impaired coordination

• Estrogen deficiency

• Low body weight

• Poor nutrition (vitamin

• X-ray hip and pelvis (first line) [14][15]

  • Hip: AP view and lateral views

  • Pelvis: AP view

• MRI hip and pelvis: preferred if an occult fracture is suspected [13]

• Other: CT hip or bone scan

• Osteonecrosis of the femoral head

• Thromboembolism

• Infection

• Chronic pain and posttraumatic arthritis

• Nonunion

• Dislocation

• Nerve injury, e.g., sciatic nerve injury

• Intracapsular fractures (e.g., femoral head and neck fractures) have an increased rate of nonunion which leads to AVN

• Intertrochanteric fractures have a good prognosis following surgery

• Subtrochanteric fractures have a high rate of implant failure

Hip fractures have a high rate of associated morbidity and mortality in older adults.

• Fall risk assessment, for example with the Tinetti-Test, which is used to evaluate a patient's gait and balance.

• Implementation of fall prevention strategies.

• Early preventative efforts such as fall training, physical therapy, removal of tripping hazards, appropriate shoes, etc.

• Osteoporosis prophylaxis