A Synopsis of AFP's "Hip Fracture: Diagnosis, Treatment, and Secondary Prevention"

A Synopsis of:

Hip Fracture: Diagnosis, Treatment, and Secondary Prevention

KIM EDWARD LeBLANC, MD, PhD, Clinical Skills Evaluation Collaboration, Philadelphia, Pennsylvania HERBERT L. MUNCIE JR., MD, Louisiana State University School of Medicine, New Orleans, Louisiana LEANNE L. LeBLANC, MD, Temple University, Philadelphia, Pennsylvania

Am Fam Physician. 2014 Jun 15;89(12):945-951

     The average age for a patient to have a hip fracture is 80 years old. Women are twice as likely as men to have one. Hip fractures are associated with poor outcome, with many patients dying within a year, or needing long term care. About one fourth regain full function. Risk factors include age above 65, family history of hip fractures, female, low bone density, prior hip fracture, and chronic use of loop diuretics, SSRI's, PPI's or levothyroxine, 

     Patients present with inability to bear weight, groin pain, or referred pain to the thigh or knee. Physical examination will show a short leg or a leg that is externally rotated and abducted. An x-ray, MRI or a bone scan can be used for diagnosis.

     The two categories of hip fracture are extracapsular and intracapsular. Extracapsular includes the intertrochanteric and subtrochanteric region. The intertrochanteric region has a good blood supply and will heal well with open reduction internal fixation. The subtrochanteric region may need an intramedullary rod or nail because it is an area of high stress. The intracapsular area has a higher incidence of avascular necrosis due to its poor blood supply and thin periosteum.

     Surgery and analgesia is the treatment of choice. Patients who get surgery within two days have a faster recovery and lower risk of complications. There is no benefit of one type of anesthesia over another. For femoral neck fractures, arthroplasty or open reduction/ internal fixation can be used. Open reduction internal fixation has a low morbidity. Arthroplasty has a lower risk of avascular necrosis. Prophylactic antibiotics and thrombolytics should be used. Low molecular weight heparin should be used 12 hours after surgery and can be used for up to 35 days.

     Patient should also be on bisphosphonate, calcium and vitamin D. Bisphosphonates, however, may increase the risk of fracture after five years of use.