Medica.

regarding hip fracture

Many of patients are unwell before breaking a hip; it is
common for the break to have been caused by a fall due
to some illness, especially in the elderly. Nevertheless,
the stress of the injury, and a likely surgery, does

increase the risk of medical illness including heart attack,

stroke, and chest infection.

Blood clots may result. Deep venous thrombosis (DVT) is

when the blood in the leg veins clots and causes pain and

swelling. This is very common after hip fracture as the

circulation is stagnant and the blood is hypercoagulable
as a response to injury. DVT can occur without causing
symptoms. A pulmonary embolism (PE) occurs when
clotted blood from a DVT comes loose from the leg veins
and passes up to the lungs. Circulation to parts of the

lungs are cut off which can be very dangerous. Fatal PE

may have an incidence of 2% after hip fracture and may
contribute to illness and mortality in other cases.

Mental confusion is extremely common following a hip

fracture. It usually clears completely, but the disorienting
experience of pain, immobility, loss of independence,
moving to a strange place, surgery, and drugs combine to
cause delirium or accentuate pre-existing dementia.

Urinary tract infection (UTI) can occur. Patients are

immobilized and in bed for many days; they are
frequently catheterised, commonly causing infection.

Prolonged immobilization and difficulty moving make it

hard to avoid pressure sores on the sacrum and heels of
patients with hip fractures. Whenever possible, early
mobilization is advocated; otherwise, alternating pressure
mattresses should be used.

Prognosis
Hip fractures are very dangerous episodes especially for
elderly and frail patients. The risk of dying from the stress
of the surgery and the injury in the first few days is about
10%.[citation needed] If the condition is untreated the pain and
immobility imposed on the patient increase that risk.

Problems such as pressure sores and chest infections are

all increased by immobility. The prognosis of untreated
hip fractures is very poor.
Post operation

Among those affected over the age of 65, 40% are

transferred directly to long-term care facilities, long-term
rehabilition facilities, or nursing homes; most of those
affected require some sort of living assistance from family
or home-care providers. 50% permanently require
walkers, canes, or cruches for mobility; all require some

sort of mobility assistance throughout the healing

process.
Among those affected over the age of 50, approximately
25% die within the next year due to complications such
as blood clots (deep venous thrombosis, pulmonary
embolism), infections, and pneumonia.[citation needed]

Patients with hip fractures are at high risk for future

fractures including hip, wrist, shoulder, and spine. After
treatment of the acute fracture, the risk of future
fractures should be addressed. Currently, only 1 in 4
patients after a hip fracture receives treatment and work
up for osteoporosis the underlying cause of most of the

fractures. Current treatment standards include the

starting of a bisphosphonate to reduce future fracture risk
by up to 50%.
Epidemiology

Approximately 320,000 hospitalizations occur each year

due to hip fractures in the US.
Elderly people are at a high risk for falling, the usual
traumatic event that leads to hip fractures. "They fall
because they lose their coordination. They have difficulty
with their eye sight and they have difficulty with their

balance, and they become weak," says Dr. Charles A.

Peterson, an orthopedic surgeon at Seattle Orthopaedic
and Fracture Clinic. "When they fall, they tend to have a
higher frequency of fractures due to osteoporosis and
weaker bones."

The risk factors for suffering a broken hip are numerous,

including:
Osteoporosis: This disease causes bones to become
weaker, making them more susceptible to fracture. In
the U.S., an estimated 10 million individuals already
have osteoporosis, and 80% of those affected are

women. In this population, hip fractures can occur

during simple weight-bearing activities.
Sex: Women lose bone density more quickly than
men due to a decrease in estrogen levels after
menopause begins.

 Heredity: Small-boned, slender-framed people;

Caucasians; and Asians have an increased risk of
suffering from osteoporosis.
Nutrition: Poor nutrition in childhood increases hipfracture risk. Eating disorders such as anorexia
nervosa and bulimia damage bones.

 Tobacco and alcohol use: Smoking and drinking too

much can lead to bone loss.
Medications: Taking four or more medications at a
time or taking any psychoactive medications are risk
factors for falling.

 Home environment: Throw rugs and electrical wires

are tripping hazards, as are a lack of stair railings
and grab bars, unstable furniture, and poor lighting.
Medical conditions: The following conditions can
increase the risk of hip fractures, either through bone
loss or by increasing the risk of falling: endocrine

disorders, such as type 1 diabetes; gastrointestinal

disorders; rheumatoid disorders; prolonged bed rest
or immobility; nervous system disorders such as
Parkinson's disease or multiple sclerosis; dementia;
and depression.
Signs and Symptoms

Most often, an individual knows right away that she has

broken her hip. For example, Lang was unable to stand up
and was discovered by her son who happened to stop by
that day. Usually severe pain is felt in the hip or groin
areas and the person cannot walk. Other symptoms
include stiffness, contusions, or inflammation in the hip

area; the leg on the broken hip side is shorter or turns

outward. If the head of the hip bone is impacted onto the
neck of the hip bone, the person might not know he has a
broken hip, as this break can be less painful, according to
Peterson.

Because hip fractures in the elderly are life-threatening,

make sure your loved one heads to a hospital
immediately. Surgery to fix the fracture is usually done
within 24 hours. The examining doctor can diagnose a
broken hip simply from symptoms, but an x-ray or MRI
will verify the break and display the fracture type.

Treatment: Surgery for Hip Fractures in the Elderly

There are two main types of hip fractures, and older
people almost always undergo surgery to repair these
breaks:

 Femoral neck fracture: The femoral neck is right

below the ball (or head) of the ball-and-socket hip
joint. Because this type of fracture diminishes and
can sometimes stop the flow of blood to the broken
part of the bone, surgery is almost always done to
correct it. Partial hip replacement, called

hemiarthroplasty, replaces the ball and femoral neck

with a metal prosthesis, usually made from stainless
steel or chrome cobalt alloy. While the patient is
under general or spinal anesthesia, the surgeon
makes an incision. The broken head is removed, and
the surgeon clears out cartilage and damaged bone

from the hip socket. The new socket, which includes

a ball and stem, is cemented in place. Muscles and
tendons are positioned around the prosthesis and the
incision is closed.If the patient has arthritis or a
previous injury that has damaged the joint and they

are physiologically sound, a total hip replacement

may be done for a femoral neck fracture.
Intertrochanteric region fracture: Just below the
femoral neck, this is where the thigh bone juts out.
The fracture runs between two bumps called
trochanters. While the patient is under general or

spinal anesthesia, the surgeon makes an incision on

the side of the thigh. The patient's bones are
manipulated to correct their position. A large screw
called a hip nail is placed along the break and up into
the femoral head. This screw is held to a metal plate
that is attached to the outside of the thigh using

several smaller screws. This plate and screw helps

the bones heal, compressing them so they grow
together.
A third type of break, called asubtrochanteric fracture,
occurs in the thigh bone or femur, and is quite rare. The
surgical repair is similar to the plate and screw system

used in intertrochanteric fractures, although the recovery

period is much longer.
In rare instances, people who have hip fractures do not
have surgery. If someone is too sick for surgery to occur,
traction or other methods are used to repair the break.

Prevention
Ideally, one can prevent hip fractures in the elderly in the
first place. People who have broken a hip also have a
good chance of falling again. You can help by making sure
your loved one's home environment is safe, as well as
seeing that she stays as healthy as possible.

Homes, rehabilitation centers, and nursing homes all

need to be fall-proofed. Ganz includes the following
recommendations in a recently published home-hazards
guide:
Lighting should not be too dim or too direct, and light
switches should be accessible.

 Carpets and rugs should be tacked down.

Bathrooms should have a chair for bathing or skidresistant mats, grab bars should be placed where
needed and the toilet seat needs to be tall enough
for easy transferring.

 Chairs need to be stable (without wheels) and have

arm rests.
Kitchen items that are frequently used should be at
waist level or on low shelves, a rubber mat should be
placed in front of the sink and non-slip wax should be
used on the floor.

 Stairways need handrails and steps should not be

slippery.
There are several other simple suggestions that can help
prevent falls and hip fractures. People need to have
regular eye-checkups; wear sensible, hard-soled flat
shoes; and be mindful of medication's side effects.

Individuals can also wear hip padding to minimize the

impact of a fall. A doctor can talk with your loved one
about how to increase her bone density through taking
supplements, including bisphosphonates for osteoporosis
sufferers, calcium, vitamin D, or starting estrogen or
hormone replacement therapy, says Ganz.

Exercise is imperative for preventing falls. Heitzman

recommends that a regimen includes:
an aerobic workout that elevates heart rate and
increases breathing capacity;

 a strength-training program that involves lifting

against resistance;
exercising on different surfaces-such as carpets,
stairs, and gravel-to challenge one's balance.

Healing from a hip fracture takes time and patience.

Seven weeks after her fall, Lang uses a walker to move
around her apartment and the world outside. Before her
accident, she occasionally used a cane for outings, saying
she found it elegant. Now she looks forward to just using

her cane. "They say you'll never be exactly how you

were, but you will be a pretty good
Preventing falls
Preventing falls is important at any age, but it is
especially important for those who have osteoporosis,

because their bones are more fragile and easily broken.

Each year, about one-third of individuals 65 years and
older will fall, and some will be disabled by the broken
bones that can follow. In many cases, a fall can be
precipitated by medicines such as sedatives, muscle
relaxants, and blood pressure drugs that can cause

dizziness, lightheadedness, or loss of balance. When two

or more medicines are used in combination, these side
effects might be worsened. Falls also result from
diminished hearing, vision, muscle strength, coordination,
and reflexes, as well as from diseases that affect balance.
What to do to reduce your risk of falls

 Regular follow-up visits Get proper medical

evaluation and treatment for conditions causing
physical changes. Do not assume you are just
"getting older."

 Floors Remove all loose wires, cords, and throw

rugs. Minimize clutter. Make sure rugs are anchored
and smooth. Keep furniture in its usual place.
Bathroom Install grab bars and non-skid tape in
the tub or shower.

 Lighting Make sure halls, stairways, and

entrances are well-lit. Install a night light in your
bathroom. Turn lights on if you get up in the middle
of the night.
Kitchen Install non-skid rubber mats near the sink
and stove. Clean spills immediately.

 Stairs Make sure treads, rails, and rugs are

secure.
Other precautions Wear sturdy, rubber-soled
shoes. Keep your intake of alcoholic beverages to a
minimum. Ask your health care provider whether any
of your medicines might cause you to fall. Avoid risky

behaviors. Do not become unduly fearful about

falling, as fear will only encourage inactivity and
immobility.
Take action Inactivity is dangerous. Exercise
improves strength, balance, coordination, and

flexibility, which can help you avoid falling in the first

place.
What is osteoporosis (brittle bones)?
Osteoporosis is a debilitating disease that can be
prevented and treated. Osteoporosis causes bones to

become fragile and, therefore, more likely to break. If not

prevented, or if left untreated, osteoporosis can progress
painlessly until a bone breaks. These broken bones, also
known as fractures, occur typically in the hip, spine, and
wrist.

Any bone can be affected, but of special concern are

fractures of the hip and spine. A hip fracture almost
always requires hospitalization and major surgery. It can
impair a person's ability to walk unassisted and might
cause prolonged or permanent disability or even death.
Spinal or vertebral fractures also have serious

consequences, including loss of height, severe back pain,

and deformity.
Millions of Americans are at risk of developing
osteoporosis. Although women are four times more likely
than are men to develop the disease, men also suffer
from osteoporosis.

Para la introduccion
You can break your hip at any age, but the great majority
of hip fractures occur in people older than 65. As you age,
your bones slowly lose minerals and become less dense.

Gradual loss of density weakens bones and makes them

more susceptible to a hip fracture.
A hip fracture is a serious injury, particularly if you're
older, and complications can be life-threatening.
Fortunately, surgery to repair a hip fracture is usually

very effective, although recovery often requires time and

patience

Facts of the fracture

Fracture proximal femur is a very common orthopaedic
traumatic condition seen in the elderly after fall. The
most common forms are fracture neck of femur (abrev. #
NOF) and intertrochanteric fracture of femur (abrev. #
TOF).

Both fractures can be classified into undisplaced,

displaced and complete, incomplete; and the treatments
vary accordingly.

All completed fractures need to fix with internal

fixation to facilitate early walking and rehabilitation.
Fracture neck of femur (abrev. # NOF)
Due to the proximity of the feeding vessels to the
femoral head in the neck of femur, displaced fracture in

this region invariably leads to avascular necrosis of the

femoral head even when the fracture has healed initially.

Other complications can include:

pneumonia

 muscle atrophy (wasting of muscle tissue)

post-operative infection
non-union or improper union of the bone

 mental deterioration following surgery in older

patients
bedsores from lying in the same position with
minimal movement

With some fractures, blood cannot circulate properly to

the femoral head, resulting in a loss of blood supply to
this area. This is called femoral vascular necrosis or
avascular necrosis. This complication may occur
depending on the type of fracture and the anatomy of a

person's blood supply to the head of the femur bone. This

is more common with femoral neck fractures.
Prevention of hip fracture:
Preventing a hip fracture is more desirable than treating
one. Preventive measures include taking in enough

calcium every day. For women past menopause and not

taking estrogen, the National Institutes of Health (NIH)
recommends 1,500 milligrams (mg) daily. For those
taking estrogen, the recommendation is 1,000 mg.
Middle-aged men should take 1,000 mg daily.

Women at menopause should consider having a bone

density test. A bone density test is used to measure the
bone mineral content and thickness of the bone. This
measurement can indicate decreased bone mass, a
condition in which bones are more brittle and more prone
to break or fracture easily. A bone density test is used

primarily to diagnose osteoporosis and to determine

fracture risk.
Women, who sustain the majority of hip fractures,
produce less estrogen when menopause begins. Most
people do not know they have osteoporosis until they
sustain a fracture.

Another way to help prevent hip fracture is to engage in

regular weight-bearing exercise such as walking, jogging,
or hiking. Exercise programs such as Tai Chi help promote
strength and balance.
Other preventive measures may include:

 taking medications as prescribed by your physician

to prevent bone loss
eating a calcium-rich diet including milk, cottage
cheese, yogurt, sardines, and broccoli
stopping smoking

 avoiding excessive alcohol use

keeping objects off the stairs and floors, such as
electrical cords, to prevent falls
using slip-resistant rugs next to the bathtub and
installing grab bars in the tub

 positioning night lights from the bedroom to the

bathroom
using rug pads or non-skid backing to keep rugs in
place

 not using unsteady furniture or step ladders to stand

on
visiting an ophthalmologist every year to have vision
checked annually and vision loss treated

Another way to help prevent hip fracture is to engage in

regular weight-bearing exercise such as walking, jogging,
or hiking. Exercise programs such as Tai Chi help promote
strength and balance.
Other preventive measures may include:

Intertrochanteric fractures occur slightly further down the

bone and the fracture line crosses the Inter-trochanteric
line between the two trochanters at the upper end of the
femur. Because the fracture is lower the blood supply of
both fragments is usually intact. This improves the

chance of healing and reduces the likelihood of avascular

necrosis.

You can break your hip at any age, but the great majority
of hip fractures occur in people older than 65. As you age,

your bones slowly lose minerals and become less dense.

Gradual loss of density weakens bones and makes them
more susceptible to a hip fracture.
A hip fracture is a serious injury, particularly if you're
older, and complications can be life-threatening.
Fortunately, surgery to repair a hip fracture is usually

very effective, although recovery often requires time and

patience
A hip fracture is a break in the femur (thigh bone) of the
hip joint. Joints are areas where two or more bones meet.
The hip joint is a "ball and socket" joint where the femur
meets the pelvic bone. The ball part of the hip joint is the

head of the femur, and the socket is a cup-like structure

in the pelvic bone called the acetabulum. Hip fracture is a
serious injury and requires immediate medical attention.
Our hip joint is a ball-in-socket joint. Our pelvis bone has
a cup-shaped socket that holds the top of our thigh bone
in place and allows it to rotate during movement. The

cup-shaped socket is called the Acetabulum. Our thigh

bone is called the Femur and is the strongest bone in the
body. The top of the Femur is shaped like a ball and
called the Femoral Head. The Acetabulum and the
Femoral Head form our hip joint.

The Femoral Head is attached to the Femur by small

section of bone called the Femoral Neck. The Femoral
Neck attaches to the Femur between two projections of
bone called the Greater Trochanter and the Lesser
Trochanter. The long length of bone on the femur that we

refer to as our thighbone is called the Shaft.

The primary function of the Hip Joint is to support the
weight of our head, trunk, and arms while we are still or
moving. The Hip Joint provides a base of support that
allows us to hold our body upright when we sit or stand.

Likewise, the Hip Joint provides stability for our upper

body while positioning the lower body for movement.
The Hip Joint allows our legs to move to the front and
back and from side to side as we walk, run, and climb
stairs. The Hip Joint also allows our legs to rotate inward
and outward. We rotate our legs when we place our feet

on the ground. We angle our toes inward or outward for

balance.

A fracture is a partial or complete break in a bone. There

can be either a single break or multiple breaks in a bone.

A hip fracture is classified