Hip Fractures

Intertrochanteric femur fracture and intracapsular fracture neck femur are common fractures in hip region. Intertrochanteric femur fracture amounts to 50% of proximal femur fractures.

Incidence is common in elderly. More common in females. It second highest osteoporotic fracture and commonest osteoporotic fracture of lower extremity. Weakened bones with age, vision impairment, balance problems predisposes elderly to these fractures. In elderly usually this is result of a trivial fall while in youngsters it develops after high velocity trauma. Hip fractures almost always require surgical fixation or replacement. Maintaining bone density and preventing falls can help in minimizing hip fractures.

Symptoms

Inability to get up after a fall
Unable to walk or lift leg
Pain in hip region
Shortened leg
Outwardly rotated leg
Bruising or swelling in hip region can be seen in some patients

Risk Factors

Age – more common in elderly. Bone density tend to decrease with age.
Sex – More common in females. Women develop osteoporosis early and faster than males due to hormonal changes at menopause.
Osteoporosis
Lack of exercises – lead to weakened bones and muscles.
Chronic medical conditions and medications – endocrine disorders, rheumatoid arthritis, corticosteroid treatment can lead to weakening of bones. Low blood pressure and low blood sugar can contribute to falls.
Tobacco and alcohol use- can lead to bone loss.

Complications

Hip fractures can reduce mobility for long time. Complications can be as follows

Development of blood clots in legs or chest
Bed sores
Chest infections
Urinary tract infections
Non union, malunion, delayed union
Worsening of existing medical problems
Death

Prevention

Maintaining healthy bones and preventing falls can prevent and reduce hip fracture incidences

Get adequate calcium and vitamin D – Balanced diet, sunlight exposure, supplements as per advice are important.
Regular physical exercises – regular physical exercise helps in maintaining bone density.
Proper control of blood pressure and sugar – low blood pressure and sugar can contribute to fall.
Vision check up – regular eye check up can reduce trivial falls at home
Avoid smoking and alcohol – helps to maintain bone density
Using stick while walking – useful in minimizing the number of falls in elderly
Remove obstacles in living room – loose wires, slippery floor mats

Diagnosis and Treatment

Diagnosis is usually done by clinical examination and X ray. Further evaluation with CT scan and MRI may be needed in few patients.

Treatment depends on type of fracture, Age and medical condition of patient. Most of hip fractures require surgical intervention. Intertrochanteric fractures are commonly fixed with hip screws or proximal femoral nails. Intracapsular fracture neck femur in elderly are usually treated with partial or total hip replacement, fixation may be necessary in young patients.