A hip fracture is a fracture in the proximal end of the femur (the long bone running through the thigh), near the hip joint. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... It has been suggested that this article or section be merged with Bone healing. ... In zootomy, several terms are used to describe the location of organs and other structures in the body of bilateral animals. ... The femur or thigh bone is the longest, most voluminous, and strongest bone of the human body. ... Diagram of the human thigh bone In humans the thigh is the area between the pelvis and buttocks and the knee. ... In anatomy, the hip is the bony projection of the femur which helps you shake your ass. ...

The term "hip fracture" is commonly used to refer to four different fracture patterns and is often due to osteoporosis; in the vast majority of cases, a hip fracture is a fragility fracture due to a fall or minor trauma in someone with weakened osteoporotic bone. Most hip fractures in people with normal bone are the result of high-energy trauma such as car accidents. Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... A fragility fracture is one that occurs as a result of a fall from standing height or less. ... Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... This article does not cite its references or sources. ...

The mortality following a hip fracture is between 20% and 35% within one year in patients aged 82 ± 7 years old, of which 80% were women and 19% were men.^[1]

Types

Many subtypes of fractures about the hip joint are colloquially known as 'hip fractures'. Although a true hip fracture involves the joint, the following four proximal femur fractures are commonly referred to as 'hip fractures'. The differences between them are important because each is treated differently.

• Femoral head fracture denotes a fracture involving the femoral head. This is usually the result of high energy trauma and a dislocation of the hip joint often accompanies this fracture.
• Femoral neck fracture (sometimes Neck of Femur (NOF), subcapital, or intracapsular fracture) denotes a fracture adjacent to the femoral head in the neck between the head and the greater trochanter. These fractures have a propensity to damage the blood supply to the femoral head, potentially causing avascular necrosis.
• Intertrochanteric fracture denotes a break in which the fracture line is between the greater and lesser trochanter on the intertrochanteric line. It is the most common type of 'hip fracture' and prognosis for bony healing is generally good if the patient is otherwise healthy.
• Subtrochanteric fracture actually involves the shaft of the femur immediately below the lesser trochanter and may extend down the shaft of the femur.

Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. ... Running obliquely downward and medialward from the tubercle of the femur is the intertrochanteric line (spiral line of the femur); it winds around the medial side of the body of the bone, below the lesser trochanter, and ends about 5 cm. ... The femur or thigh bone is the longest, most voluminous, and strongest bone of the human body. ...

Incidence

Approximately 320,000 hospitalizations occur each year due to hip fractures in the US. Bones of the Hip In anatomy, the hip is the bony projection of the femur, known as the greater trochanter, and the overlying muscle and fat. ...

Pathogenesis/risk factors

Most hip fractures occur as a result of low-energy falls in elderly patients. Falls are uncommon in young adults due to better balance and strength and when they do occur, they usually do not cause the "hip fracture" pattern of injury that is commonly seen in the elderly. It was formerly thought, but Harvard medical scientists disproved, that benzodiazepine use increased the risk. The most common cause of weakness in bone is

• osteoporosis. Hip fractures are one of the most serious complications of osteoporosis; in fact a measure of success or failure of treatment of osteoporosis is the proportion of patients who sustain a hip fracture.

• Other metabolic bone diseases such as Paget's disease, osteomalacia, osteopetrosis and osteogenesis imperfecta. Stress fractures may occur in the hip region with metabolic bone disease.
• Benign or malignant primary bone tumours are rare causes of hip fractures.
• Metastatic cancer deposits in the proximal femur may weaken the bone and cause a pathological hip fracture.
• Infection in the bone is a rare cause of hip fracture.

Another element in the risk of sustaining a hip fracture is the risk of falling. Fall prevention is an area if interest with concerns in the area of providing a safe environment for people at risk, custodial care, walking aids, medication issues etc. Hip protectors are padded plastic shields that can be placed over the trochanters of people at risk of falling or of sustaining a fragility fracture. However, they are not effective in reducing the likelihood of a hip fracture and compliance is poor. Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... Sir James Paget, a prolific surgeon and pathologist, described several diseases, all called Pagets disease: The term is most commonly used to refer to Pagets disease of bone It can also mean Pagets disease of the breast Or: Pagets disease of the penis. ... To meet Wikipedias quality standards, this article may require cleanup. ... Osteopetrosis is an extremely rare inherited disorder whereby the bones harden, becoming denser. ... Osteogenesis imperfecta (sometimes known as Brittle Bone Disease) is a genetic bone disorder. ... A stress fracture is one type of incomplete fractures in bones. ... An arm bone tumor Bone tumor is an inexact term, which can be used for both benign and malignant abnormal growths found in bone, but is most commonly used for primary tumors of bone, such as osteosarcoma (or osteoma). ... Metastasis (Greek: change of the state) is the spread of cancer from its primary site to other places in the body. ... Osteomyelitis is an infection of bone, usually caused by pyogenic bacteria or mycobacteria. ... AHIP Protector Hip protectors are a quite new method for the prevention of hip fractures. ... Bones of the Hip In anatomy, the hip is the bony projection of the femur, known as the greater trochanter, and the overlying muscle and fat. ...

Natural history

Hip fractures are very dangerous episodes especially for elderly and frail patients. The risk of dying from the stress of the surgery and the injury in the first few days is about 10%. If the condition is untreated the pain and immobility imposed on the patient increase that risk. Problems such as pressure sores and chest infections are all increased by immobility. The prognosis of untreated hip fractures is very poor. Bedsores, also called pressure sores or decubitus ulcers, are ulcers (sores) caused by prolonged pressure or rubbing on vulnerable areas of the body. ... Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed and flooded with fluid. ...

Clinical features

The classic clinical presentation of a hip fracture is an elderly patient who sustained a low-energy fall and now has pain and is unable to bear weight. On exam, the affected extremity is often shortened and externally rotated.

Investigations

X-rays of the affected hip usually make the diagnosis obvious; AP and lateral views should be obtained.

In situations where a hip fracture is suspected but is not obvious on x-ray, a CT scan with 3D reconstruction may be helpful. MRI has gained importance in the diagnosis of occult fractures of the femoral neck. Within 24 hours changes can be seen on MRI. Bone scan is less useful because it may take up to 1 week to demonstrate changes especially in the elderly.

As the patients most often require an operation, full pre-operative general investigation is required. This would normally include blood tests, ECG and chest x-ray.

Femoral neck fracture

Femoral neck fractures involve the narrow neck between the round head of the femur and the shaft. This fracture often disrupts the blood supply to the head of the femur.

Gardner classified this fracture into four types:

• Type 1 is a stable fracture with impaction in valgus.
• Type 2 is complete but non-displaced.
• Type 3 is displaced (often rotated and angulated) with varus displacement but still has some contact between the two fragments.
• Type 4 is completely displaced and there is no contact between the fracture fragments.

The blood supply of the femoral head is much more likely to be disrupted in Garden types 3 or 4 fractures.

Garden Type 1 Fractured Neck of Femur

Image:Nof garden3.jpg Garden Type 3 Fractured Neck of Femur

Image:Nof pauwels3.jpg Pauwels type 3 (high angle) Fractured Neck of Femur

Surgeons may treat these types of fracture by replacing the fractured bone with a prosthesis arthroplasty. Alternatively the treatment is to reduce the fracture (manipulate the fragments back into a good position) and fix them in place with three metal screws. Image File history File links Nof_garden2. ... Image File history File links Nof_garden2. ... Arthroplasty (literally formation of joint) is an operative procedure of orthopaedic surgery performed for replacing the arthritic or dysfunctional joint surface with something better or remodeling or realigning the joint by osteotomy or some other procedures. ...

A serious but common complication of a fractured femoral neck is avascular necrosis. The vasculature to the femoral head is easily disturbed during fractures or from swelling inside the joint capsule. This can lead to strangulation of the blood supply to the femoral head and death of the bone and cartilage. Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. ...

Intertrochanteric fracture

Intertrochanteric fractures occur between the greater and lesser trochanters. They are usually fixed with a sliding hip screw and plate. Healing is usually good when the patient is healthy.

See also

• Hip fracture treatment

Hip fractures are treated in one of two ways: Traction or orthopedic surgery. ...

References

1. ^ http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=129634

External links

Wikimedia Commons has media related to:

Category:Hip fractures

• Orthopedics.com article on hip fractures
• American Academy of Orthopedic Surgeons article on hip fractures
• Fractures of the Femoral Neck Wheeless Textbook of Orthopaedics
• Intertrochanteric Fractures Wheeless' Textbook of Orthopaedics
• Proximal femoral fracture Musculoskeletal Radiology of Fractures
• Hip fractures