Hip fracture

Question 1

What are the classifications of hip fractures?

Answer 1

(Intracapsular and extracapsular) Extracapsular can then either be trochanteric or subtrocanteric based on lesser trocanter

(Gardener’s) Type I: Stable fracture with impaction in valgus
Type II: Complete fracture but undisplaced
Type III: Displaced fracture, usually rotated and angulated, but still has boney contact
Type IV: Complete boney disruption

Question 2

What are risk factors to hip fractures?

Answer 2

Osteoporosis (especially post-menopausal women and elderly)
Muscle weakness
Difficulty walking and impaired coordination
Estrogen deficiency
Low body weight
Poor nutrition (vitamin D or calcium deficiency)
Smoking, alcohol use

Question 3

What are the clinical features of hip fractures?

Answer 3

(Femoral neck fracture) Groin pain
Shortened and externally rotated leg
(Trochanteric fracture) greater trochanter: fracture is suggested by local pain exacerbated by abduction
lesser trochanter: fracture presents with groin pain, which radiates to the knee or posterior thigh, and worsens with hip flexion and rotation
(Subtrochanteric fracture) Hip pain with swelling
Shortened and externally rotated leg
(Intertrochanteric fracture) Hip pain and swelling
Shortened and externally rotated leg

Question 4

How are fractures diagnosed?

Answer 4

(X-ray)

MRI

Question 5

What is the treatment for hip fractures?

Answer 5

Intracapsular hip fracture
(Undisplaced Fracture)
internal fixation, or hemiarthroplasty if unfit.
(Displaced Fracture)
young and fit i.e. <70 years- Reduction and internal fixation (if possible)
older and reduced mobility- Hemiarthroplasty or total hip replacement.

Extracapsular hip fracture - dynamic hip screw
(if reverse oblique, transverse or subtrochanteric) -intramedullary device