Hip fracture: Difference between revisions
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In [[medicine]], '''hip fractures''' are "[[bone fractures|fractures]] of the [[femur head]]; the [[femur neck]]; (femoral neck fractures); the trochanters; or the inter- or subtrochanteric region. Excludes fractures of the acetabulum and fractures of the femoral shaft below the subtrochanteric region ([[femoral fracture]]s)."<ref>{{MeSH}}</ref> | In [[medicine]], '''hip fractures''' are "[[bone fractures|fractures]] of the [[femur head]]; the [[femur neck]]; (femoral neck fractures); the trochanters; or the inter- or subtrochanteric region. Excludes fractures of the acetabulum and fractures of the femoral shaft below the subtrochanteric region ([[femoral fracture]]s)."<ref>{{MeSH}}</ref> | ||
==Classification== | ==Classification== | ||
{{Image|Bartleby-image243.gif|right|350px|Upper right [[femur]] viewed from behind and above.}} | {{Image|Bartleby-image243.gif|right|350px|Upper right [[femur]] viewed from behind and above.}} | ||
Intracapsular fractures | |||
* Femoral head fracture | * Femoral head fracture | ||
* [[Femoral neck fracture]]s | * [[Femoral neck fracture]]s | ||
Extracapsular fractures | |||
* Intertrochanteric fractures | * Intertrochanteric fractures | ||
* Subtrochanteric fractures | * Subtrochanteric fractures. These are 2-4% of all hip fractures<ref>{{Cite journal | ||
| doi = 10.1056/NEJMe1003064 | |||
| pages = NEJMe1003064 | |||
| last = Shane | |||
| first = Elizabeth | |||
| title = Evolving Data about Subtrochanteric Fractures and Bisphosphonates | |||
| journal = N Engl J Med | |||
| accessdate = 2010-03-25 | |||
| date = 2010-03-24 | |||
| url = http://content.nejm.org | |||
}}</ref>; some may be a rare [[drug toxicity]] of [[bisphosphonate]] medications used to treat [[osteoporosis]].<ref>{{Cite journal | |||
| doi = 10.1056/NEJMoa1001086 | |||
| pages = NEJMoa1001086 | |||
| last = Black | |||
| first = Dennis M. | |||
| coauthors = Michael P. Kelly, Harry K. Genant, Lisa Palermo, Richard Eastell, Christina Bucci-Rechtweg, Jane Cauley, Ping Chung Leung, Steven Boonen, Arthur Santora, Anne de Papp, Douglas C. Bauer, the Fracture Intervention Trial and HORIZON Pivotal Fracture Trial Steering Committees | |||
| title = Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur | |||
| journal = N Engl J Med | |||
| accessdate = 2010-03-25 | |||
| date = 2010-03-24 | |||
| url = http://content.nejm.org/cgi/content/abstract/NEJMoa1001086v1 | |||
}}</ref>. | |||
==Etiology== | ==Etiology== | ||
| Line 12: | Line 38: | ||
==Treatment== | ==Treatment== | ||
Surgical treatment is optimal.<ref name="pmid18646065">{{cite journal |author=Handoll HH, Parker MJ |title=Conservative versus operative treatment for hip fractures in adults |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD000337 |year=2008 |pmid=18646065 |doi=10.1002/14651858.CD000337.pub2 |url=http://dx.doi.org/10.1002/14651858.CD000337.pub2 |issn=}}</ref> | Surgical treatment is optimal, especially for intracapsular fractures.<ref name="pmid18646065">{{cite journal |author=Handoll HH, Parker MJ |title=Conservative versus operative treatment for hip fractures in adults |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD000337 |year=2008 |pmid=18646065 |doi=10.1002/14651858.CD000337.pub2 |url=http://dx.doi.org/10.1002/14651858.CD000337.pub2 |issn=}}</ref> | ||
For incomplete intertrochanteric fractures, conservative therapy is an option.<ref name="pmid16129752">{{cite journal| author=Alam A, Willett K, Ostlere S| title=The MRI diagnosis and management of incomplete intertrochanteric fractures of the femur. | journal=J Bone Joint Surg Br | year= 2005 | volume= 87 | issue= 9 | pages= 1253-5 | pmid=16129752 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=16129752 | doi=10.1302/0301-620X.87B9.16558 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
The use of light sedation with [[propofol]] may reduce postoperative [[delirium]] in [[geriatrics|geriatric]] patients as compared with deep sedation.<ref name="pmid20042557">{{cite journal| author=Sieber FE, Zakriya KJ, Gottschalk A, Blute MR, Lee HB, Rosenberg PB et al.| title=Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. | journal=Mayo Clin Proc | year= 2010 | volume= 85 | issue= 1 | pages= 18-26 | pmid=20042557 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20042557 | doi=10.4065/mcp.2009.0469 | pmc=PMC2800291 }} </ref> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 08:32, 5 August 2010
In medicine, hip fractures are "fractures of the femur head; the femur neck; (femoral neck fractures); the trochanters; or the inter- or subtrochanteric region. Excludes fractures of the acetabulum and fractures of the femoral shaft below the subtrochanteric region (femoral fractures)."[1]
Classification
Upper right femur viewed from behind and above.
Intracapsular fractures
- Femoral head fracture
- Femoral neck fractures
Extracapsular fractures
- Intertrochanteric fractures
- Subtrochanteric fractures. These are 2-4% of all hip fractures[2]; some may be a rare drug toxicity of bisphosphonate medications used to treat osteoporosis.[3].
Etiology
Osteoporosis and accidental falls are risk factors.
Treatment
Surgical treatment is optimal, especially for intracapsular fractures.[4]
For incomplete intertrochanteric fractures, conservative therapy is an option.[5]
The use of light sedation with propofol may reduce postoperative delirium in geriatric patients as compared with deep sedation.[6]
References
- ↑ Anonymous (2024), Hip fracture (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Shane, Elizabeth (2010-03-24). "Evolving Data about Subtrochanteric Fractures and Bisphosphonates". N Engl J Med: NEJMe1003064. DOI:10.1056/NEJMe1003064. Retrieved on 2010-03-25. Research Blogging.
- ↑ Black, Dennis M.; Michael P. Kelly, Harry K. Genant, Lisa Palermo, Richard Eastell, Christina Bucci-Rechtweg, Jane Cauley, Ping Chung Leung, Steven Boonen, Arthur Santora, Anne de Papp, Douglas C. Bauer, the Fracture Intervention Trial and HORIZON Pivotal Fracture Trial Steering Committees (2010-03-24). "Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur". N Engl J Med: NEJMoa1001086. DOI:10.1056/NEJMoa1001086. Retrieved on 2010-03-25. Research Blogging.
- ↑ Handoll HH, Parker MJ (2008). "Conservative versus operative treatment for hip fractures in adults". Cochrane Database Syst Rev (3): CD000337. DOI:10.1002/14651858.CD000337.pub2. PMID 18646065. Research Blogging.
- ↑ Alam A, Willett K, Ostlere S (2005). "The MRI diagnosis and management of incomplete intertrochanteric fractures of the femur.". J Bone Joint Surg Br 87 (9): 1253-5. DOI:10.1302/0301-620X.87B9.16558. PMID 16129752. Research Blogging.
- ↑ Sieber FE, Zakriya KJ, Gottschalk A, Blute MR, Lee HB, Rosenberg PB et al. (2010). "Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair.". Mayo Clin Proc 85 (1): 18-26. DOI:10.4065/mcp.2009.0469. PMID 20042557. PMC PMC2800291. Research Blogging.