FRACTURES OF THE PROXIMAL FEMUR (HIP FRACTURES)

Hip fractures in elderly people with osteoporotic (weak) bone frequently occur following simple falls. In younger people, a moderately severe trauma is required to produce a fracture in this region.

Classify fractures by their anatomic location (Figure 18.46):

Figure 18.46
::	Intra-capsular (femoral neck fractures)
::	Extra-capsular: intertrochanteric
::	Extra-capsular: subtrochanteric.

In intra-capsular fractures, the blood supply to the femoral head is disrupted. This may lead to the secondary complication of avascular necrosis of the femoral head.

Evaluation

Make the diagnosis from a history of a fall, pain about the hip and inability to bear weight on the extremity.

The physical examination reveals a leg that is shortened and externally rotated. The pain is made worse by attempted motion of the hip, especially with rotation. Confirm diagnosis by X-ray.

Treatment
Intra-capsular fractures

Treat with internal fixation or prosthetic replacement of the femoral head. If this cannot be done:

Extra-capsular fractures

Treat with Perkin’s traction (see page 17–5) or surgical fixation. Perkin’s traction will maintain the fracture position while permitting the patient to sit up to move the knee and hip joint, preventing pressure sores and pneumonia.