High energy trauma in young people, a full trauma evaluation and resuscitation is indicated. Needless to say, care of the patient mustīe directed to the whole patient, and not just the bony injury. They typically will be unable to bear weight and report Present with an acute hip fracture after a high-energy trauma such as a motor Heralded by severe, persistent groin pain. Simply twisting while lying in bed or standing erect. In some cases, the “trauma” may be nothing more than The most commonly encountered scenario isĪn older patient presenting after a low-energy trauma, such as a simple fallįrom standing height. Usually present with groin pain and, in the case of displacement, a shortened Trochanter, can flex the proximal fragment of a subtrochanteric fracture.īoth young and old people with a hip fracture Lastly, the iliopsoas, which inserts on the lesser Piriformis, superior and inferior gemelli, obturator internus, and quadratusįemoris (the so-called short external rotators) can externally rotate the Instance, the gluteus medius and minimus can abduct the greater trochanter. Hip fractures can be displaced by gravityĪnd the pull of various muscles attached to the fracture fragments. Normal alignment (“reduced anatomically”) and held in place with a suitableįixation device, the fracture usually unites uneventfully. When an intertrochanteric fracture is restored to All of these features enhanceįracture healing potential. Intertrochanteric region of the femur is well-lined with periosteum and has relativelyĭense cancellous bone and robust blood supply. Thus, avascular necrosis (osteonecrosis) of the femoral head can result Supply running along the neck can deprive the femoral head of necessary (Figure courtesy of Mr Peter Smitham PhD FRCS (Tr & Orth), FRACS, University of Adelaide.)Ĭompromised by the lack of blood supply. As shown, perfusion of the femoral head relies in vessels that ascend the femoral neck, which are at risk when the femoral neck has been fractured. Head, the femoral neck, the greater and lesser trochanters, and the proximalįigure 4: The blood supply to the hip. Hip fracture patients have excellent rehabilitation potential and must beĪstutely assessed and adeptly managed to optimize post-injury function. Its treatment no doubt contributes to this mortality risk. Senescence and decline, though the added biological stress of the fracture and Hip fractures from falls are a marker for One third of elderly patients with a low energy hip fracture are apt to die Into the world under the brim of the pelvis and go out through the neck of theįemur,” hip fractures are indeed associated with a high mortality risk. These fractures impose great burdens on patients, Many of theseįractures are associated with osteoporosis, other medical conditions that causeįalls, and generalized frailty. Mechanism of injury such as a fall from a standing height. Instance), but most cases are seen in older patients after a low energy Patients with high energy mechanisms of injury (a motor vehicle collision, for Typically connotes an injury to the femoral neck or the region between the greaterĪnd lesser trochanters, so-called inter-trochanteric fractures. Trochanters, and the proximal femoral shaft, the term "hip fracture" Acetabulum, the femoral head, the femoral neck, the greater and lesser
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