Hip fracture is the most common serious injury in the elderly population and the most common reason for being admitted to an orthopaedic ward. It is a major cause of mortality and morbidity.
1. Fracture/No fracture?
Treatment is almost always surgery. Conservative management is rarely considered. It is important to consider that the majority of neck of femur fractures occur in the elderly population. The consequence of not operating would mean extended bed rest. The resulting immobility can have disastrous consequences such as thromboembolism and development of pneumonia. Therefore speed is always of the essence in treating neck of femur fractures.
Surgical options include:
1. Internal fixation: for undisplaced fractures. This includes:
2. Arthroplasty: for displaced fractures. This includes:
The important issue to consider in deciding the surgical option is the risk of developing avascular necrosis. See picture "Blood supply to femoral neck" below. Briefly, there are 3 main supplies to the femoral neck:
1. Intramedullary vessels
2. Circumflex arteries branching into retinacular arteries
3. Artery to head of femur within ligamentum teres - provides only a very small supply of blood
In displaced fractures, there is greater likelihood of disruption to the intramedullary and circumflex/retinacular vessels supplying the femoral head. Therefore arthroplasty is best option in most displaced neck of femur fractures.
Also important to consider:
- Venous thromboembolism prophylaxis
- Early mobilisation post-surgery (same day or day after surgery)
- Multidisciplinary team approach to rehabilitation
- Prevention of further hip fractures through:
>Treatment of osteoporosis
Solomon L, Warwick DJ, Nayagam S. (2005) Injuries of the Hip and Femur. In: Solomon L, Warwick DJ, Nayagam S. (Ed.) Apley's Concise System of Orthopaedics and Fractures. 3rd ed. (pp362-365) London: Hodder Arnold.
Collier J, Longmore M, Turmezei T, Mafi AR. (2010) Orthopaedics and Trauma. In: Collier J, Longmore M, Turmezei T, Mafi AR (Ed.) Mini Oxford Handbook of Clinical Specialties. 8th ed. (pp 752-753) Oxford: Oxford University Press.
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