Femoral Neck Hip Fracture: Difference between revisions
No edit summary |
No edit summary |
||
Line 18: | Line 18: | ||
== Epidemiology /Etiology == | == Epidemiology /Etiology == | ||
Different events can form the basis of a hip fracture.<br>Young adult hip fractures are generally the result of high-energy trauma, and the larger peak seen in the elderly population is low-energy injuries, like a fall caused by gait and/or balance disorders.<ref name="bron vier" /> Hip fractures are regarded as the most common type of fall-related injury among elderly because of their high morbidity, mortality and impairment in quality of life.<ref name="bron vijf">TANNER ET AL. Hip fracture types in men and women change differently with age. BMC Geriatrics. 2010, 10:12</ref> ''(level of evidence | Different events can form the basis of a hip fracture.<br>Young adult hip fractures are generally the result of high-energy trauma, and the larger peak seen in the elderly population is low-energy injuries, like a fall caused by gait and/or balance disorders.<ref name="bron vier" /> Hip fractures are regarded as the most common type of fall-related injury among elderly because of their high morbidity, mortality and impairment in quality of life.<ref name="bron vijf">TANNER ET AL. Hip fracture types in men and women change differently with age. BMC Geriatrics. 2010, 10:12</ref> ''(level of evidence C)'' | ||
[[Osteoporosis|Osteoporosis]] is currently considered a chronic condition characterized by a reduction in bone mass, usually because of aging, leading to a reduction in bone strength and an increase in the risk of fracture. Women are more likely to have a hip fracture than men.<ref name="bron twee">DRAGOI D., POPESCU R. ET AL. A multidisciplinary approach in patients with femoral neck fracture on an osteoporotic basis. Romanian Journal of Morphology and Embryology 2010, 51(4):707–711</ref> A stress injury occurs when abnormal stress, usually in the form of frequent repetition of otherwise normal stress, is exerted on a bone with normal elastic resistance but unaccustomed to that action. Stress fractures, mostly tibia and [[Femoral Fractures|femoral fractures]], are common in athlete and military populations, in which subjects are exposed to a sudden increase in physical training.<ref name="bron twee">NIVA ET AL. Bone Stress Injuries Are Common in Female Military Trainees. Clinical Orthopaedic Related Research (2009) 467:2962–2969</ref> ''(level of evidence B)'' | [[Osteoporosis|Osteoporosis]] is currently considered a chronic condition characterized by a reduction in bone mass, usually because of aging, leading to a reduction in bone strength and an increase in the risk of fracture. Women are more likely to have a hip fracture than men.<ref name="bron twee">DRAGOI D., POPESCU R. ET AL. A multidisciplinary approach in patients with femoral neck fracture on an osteoporotic basis. Romanian Journal of Morphology and Embryology 2010, 51(4):707–711</ref> A stress injury occurs when abnormal stress, usually in the form of frequent repetition of otherwise normal stress, is exerted on a bone with normal elastic resistance but unaccustomed to that action. Stress fractures, mostly tibia and [[Femoral Fractures|femoral fractures]], are common in athlete and military populations, in which subjects are exposed to a sudden increase in physical training.<ref name="bron twee">NIVA ET AL. Bone Stress Injuries Are Common in Female Military Trainees. Clinical Orthopaedic Related Research (2009) 467:2962–2969</ref> ''(level of evidence B)'' | ||
<u>Risk factors for hip fracture include:<br></u> | <u>Risk factors for hip fracture include:<br></u> | ||
*<u></u>Osteoporosis | *<u></u>Osteoporosis | ||
*Low Bone Marrow Density <ref name="riskfactor">CAULEY A. J. Risk Factors for Severity and Type of the Hip Fracture. Journal of Bone and Mineral Research. Volume 24, Number 5, 2009</ref> ''(level of evidence | *Low Bone Marrow Density <ref name="riskfactor">CAULEY A. J. Risk Factors for Severity and Type of the Hip Fracture. Journal of Bone and Mineral Research. Volume 24, Number 5, 2009</ref> ''(level of evidence A1)'' | ||
*Age> 65 years = risk group | *Age> 65 years = risk group | ||
*Gender: women have more fractures than men | *Gender: women have more fractures than men | ||
*Physical inactivity | *Physical inactivity | ||
*and others such as alcohol use, vitamin D and calcium deficiency, smoking, ...<ref name="bron zeven">LEYTIN and BEAUDION. Reducing hip fractures in the elderly. Clinical Interventions in Aging 2011:6</ref><ref name="mayo">http://www.mayoclinic.com/health/hip-fracture/DS00185/DSECTION=risk-factors (visited on april 2011)</ref> ''(level of evidence | *and others such as alcohol use, vitamin D and calcium deficiency, smoking, ...<ref name="bron zeven">LEYTIN and BEAUDION. Reducing hip fractures in the elderly. Clinical Interventions in Aging 2011:6</ref><ref name="mayo">http://www.mayoclinic.com/health/hip-fracture/DS00185/DSECTION=risk-factors (visited on april 2011)</ref> ''(level of evidence A2)'' | ||
However the evidence that calcium supplements reduce fracture risk is lacking.<ref name="calcium">SEEMAN E. Evidence that Calcium Supplements Reduce Fracture Risk Is Lacking. Clinical Journal of the American Society of Nephrology 5: S3–S11, 2010</ref> ''(level of evidence A2)'' | However the evidence that calcium supplements reduce fracture risk is lacking.<ref name="calcium">SEEMAN E. Evidence that Calcium Supplements Reduce Fracture Risk Is Lacking. Clinical Journal of the American Society of Nephrology 5: S3–S11, 2010</ref> ''(level of evidence A2)'' |
Revision as of 17:17, 11 May 2011
Original Editors
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
Databases searched: Pubmed, PEDro, eMedicine, Medscape
Keywords searched: hip fracture, incidence femoral neck fracture, osteoporotic hip fracture, treatment hip fractures …
Definition/Description[edit | edit source]
A hip fracture is a condition in which the proximal end of the femur, near the hip joint, is broken. Such a fracture is a serious injury that occurs mostly in elderly people over 65 years and complications can be life threatening. [1] (level of evidence A1)
Clinically Relevant Anatomy[edit | edit source]
The hip joint is a ball and socket joint, formed by the head of the femur and the acetabulum of the pelvis. The convex head fits perfectly in the concave socket of the acetabulum forming a synovial joint. From an osteological viewpoint, the proximal end of the femur in four major parts, namely: femoral head, femoral neck, trochanter major and the minor trochanter. These parts are most often and most closely involved with hip fractures. The hip joint is a very sturdy joint, due to the tight fitting of the bones and the strong surrounding ligaments and muscles. [2]
Epidemiology /Etiology[edit | edit source]
Different events can form the basis of a hip fracture.
Young adult hip fractures are generally the result of high-energy trauma, and the larger peak seen in the elderly population is low-energy injuries, like a fall caused by gait and/or balance disorders.[1] Hip fractures are regarded as the most common type of fall-related injury among elderly because of their high morbidity, mortality and impairment in quality of life.[3] (level of evidence C)
Osteoporosis is currently considered a chronic condition characterized by a reduction in bone mass, usually because of aging, leading to a reduction in bone strength and an increase in the risk of fracture. Women are more likely to have a hip fracture than men.[4] A stress injury occurs when abnormal stress, usually in the form of frequent repetition of otherwise normal stress, is exerted on a bone with normal elastic resistance but unaccustomed to that action. Stress fractures, mostly tibia and femoral fractures, are common in athlete and military populations, in which subjects are exposed to a sudden increase in physical training.[4] (level of evidence B)
Risk factors for hip fracture include:
- Osteoporosis
- Low Bone Marrow Density [5] (level of evidence A1)
- Age> 65 years = risk group
- Gender: women have more fractures than men
- Physical inactivity
- and others such as alcohol use, vitamin D and calcium deficiency, smoking, ...[6][7] (level of evidence A2)
However the evidence that calcium supplements reduce fracture risk is lacking.[8] (level of evidence A2)
Characteristics/Clinical Presentation[edit | edit source]
Specific features for patients with hip fracture include:[7] [9]
- Dull ache in the groin and/or hip region [10] (level of evidence B)
- Inability to put weight on the injured leg causing immobility right after the fall [11] (level of evidence A1)
- If the femur bone is completely broken the injured leg might be shorter compared to the other leg
- Severe pain
- The patient tends to keep the injured hip as still as possible, positioning it in external rotation [11]
- A swelling might occur
Differential Diagnosis[edit | edit source]
Certain types of hip fracture are associated with an increased risk of avascular necrosis of the femoral head.
Other lower body fractures must be excluded:[12]
- Stress fractures
- Fracture of acetabulum
- Fracture of ramus pubis
Diagnostic Procedures[edit | edit source]
The diagnosis of a hip fracture is established based on patient history, physical examination and radiography. [11]
On a MRI one can see that a proximal hip fracture consists many kinds:
- Subcapital neck fracture: right below the femoral head
- Femoral neck fracture (intracapsular fracture) [12] (level of evidence B)
- Intertrochanteric fracture: between the greater and the small trochanter (extracapsular fracture) [12][9]
- Subtrochanteric fracture: 2 ½ inch below the small trochanter (extracapsular fracture) [9]
- Fracture of the greater trochanter
- Fracture of the small trochanter
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
On physical examination, the injured leg is shortened, externally rotated, and abducted in the supine position. Plain radiographs of the hip usually confirm the diagnosis. [11]
Medical Management
[edit | edit source]
add text here
Physical Therapy Management
[edit | edit source]
Prolonged bed rust can increase the risk of pressure sores en deconditioning. Therefore it’s important to start rehabilitation on the first post-operative day (on patients with a total hip replacement). This includes quadriceps strengthening exercises, isometric exercises, and flexion and extension mobilizations in the hip joint … [11]
On the second and third post-operative day the patient can start with walking between parallel bars, and later on they can walk with a walker or a cane.
Weight-bearing exercises are very important for mobility, balance, activities of daily living and quality of life[13] (level of evidence B), examples:
- stepping in different directions
- standing up and sitting down
- tapping the foot and stepping onto and off a block.
Prevention is also a part of the rehabilitation process to prevent fractures. Prevention of hip fractures should focus on preventing falls and osteoporosis.[6]
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 ANTAPUR ET AL. Fractures in the elderly: when is a hip replacement a necessity? Clinical Interventions in Aging. 2011
- ↑ KAPANDJI I.A. Bewegingsleer Deel II De Onderste Extremiteit. Bohn Stafleu Van Loghum. Houtem/Diegem 1986
- ↑ TANNER ET AL. Hip fracture types in men and women change differently with age. BMC Geriatrics. 2010, 10:12
- ↑ 4.0 4.1 DRAGOI D., POPESCU R. ET AL. A multidisciplinary approach in patients with femoral neck fracture on an osteoporotic basis. Romanian Journal of Morphology and Embryology 2010, 51(4):707–711 Cite error: Invalid
<ref>
tag; name "bron twee" defined multiple times with different content - ↑ CAULEY A. J. Risk Factors for Severity and Type of the Hip Fracture. Journal of Bone and Mineral Research. Volume 24, Number 5, 2009
- ↑ 6.0 6.1 LEYTIN and BEAUDION. Reducing hip fractures in the elderly. Clinical Interventions in Aging 2011:6
- ↑ 7.0 7.1 http://www.mayoclinic.com/health/hip-fracture/DS00185/DSECTION=risk-factors (visited on april 2011)
- ↑ SEEMAN E. Evidence that Calcium Supplements Reduce Fracture Risk Is Lacking. Clinical Journal of the American Society of Nephrology 5: S3–S11, 2010
- ↑ 9.0 9.1 9.2 http://orthoinfo.aaos.org/topic.cfm?topic=A00392 (visited on april 2011)
- ↑ DORNE and LANDER. Spontaneous Stress Fractures of the Femor Neck. AJA 144:343-347, February 1985
- ↑ 11.0 11.1 11.2 11.3 11.4 SHOBHA S. RAO, M.D., and MANJULA CHERUKURI, M.D. Management of Hip Fracture: The Family Physician’s Role. www.aafp.org/afp Volume 73, Number 12, June 15, 2006
- ↑ 12.0 12.1 12.2 LANCE C. BRUNNER,M.D., and LIZA ESHILIAN-OATES,M.D. Hip Fractures in Adults. www.aafp.org/afp February 1, 2003 Volume 67, Number 3
- ↑ ANNE M. MOSELEY, CATHERINE SHERRINGTON, STEPHEN R. LORD, ELIZABETH BARRACLOUGH, REBECCA J. ST GEORGE, IAN D. CAMERON. Mobility training after hip fracture: a randomized controlled trial. Age and Ageing 2009; 38: 74–80