MINORS MANUAL
Hip fractures are serious injuries that affect the upper part of the femur, typically involving the femoral neck, intertrochanteric region, or subtrochanteric region. These fractures are common in older adults due to osteoporosis but can also occur in younger people following high-energy trauma, such as falls or car accidents. Hip fractures compromise mobility and carry a high risk of complications, especially in the elderly.
Diagnosis
Diagnosis is suspected in patients with severe hip or groin pain following trauma, accompanied by an inability to walk or move the affected leg. Clinically, the affected leg may appear shortened and externally rotated. The diagnosis is confirmed by anteroposterior and lateral X-rays of the pelvis and hip.
If fractures are not evident on plain X-rays, computed tomography (CT) or magnetic resonance imaging (MRI) may be used.
Differential Diagnosis
Pathology | Key Characteristics |
|---|---|
Hip dislocation | Severe pain and deformity, leg in marked internal or external rotation |
Trochanteric bursitis | Lateral hip pain, no traumatic history or inability to walk |
Femoral neck stress fracture | Progressive pain, more common in athletes or individuals with low bone density |
Hip osteoarthritis | Chronic, progressive pain with gradual reduction in mobility |
Emergency Management
Initial evaluation (ABC): Ensure the patient’s haemodynamic stability, especially in elderly patients who may have comorbidities.
Immobilisation: Keep the affected limb immobilised to prevent further displacement and reduce pain. Use a splint or cushion.
Pain relief: Administer analgesics such as NSAIDs or opioids to manage acute pain.
Immediate X-rays: Order X-rays of the pelvis and hip to confirm the fracture and determine its exact location.
Haemodynamic stabilisation: In older patients, ensuring cardiovascular stability before surgery is crucial, as early surgery reduces complications.
Thromboembolism prevention: Initiate thromboprophylaxis (low molecular weight heparin or compression devices) to reduce the risk of deep vein thrombosis.
Definitive Treatment
Definitive treatment depends on the type and location of the fracture:
Intracapsular fractures (femoral neck): Surgical management is the standard option. Non-displaced fractures can be treated with internal fixation using cannulated screws. Displaced fractures, especially in older patients, typically require partial or total hip replacement (arthroplasty).
Intertrochanteric fractures: These fractures are generally managed with open reduction and internal fixation (ORIF), using plates or intramedullary nails to stabilise the fragments.
Subtrochanteric fractures: This type of fracture is also managed with intramedullary nails or compression plates.
In younger patients with good bone quality, the goal is to preserve the joint through internal fixation.
In elderly patients, the focus is on quickly restoring mobility through arthroplasty, as prolonged immobility increases the risk of severe complications such as thromboembolism, infections, and loss of function.
Postoperative rehabilitation is essential, with early mobilisation and physical therapy to restore mobility and reduce complications associated with immobility.
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