Description
This book describes Hip Neck Fracture, Diagnosis and Treatment and Related DiseasesHip Neck Fracture is becoming more frequent nowadays especially with old age.Recently I had an elderly relative (man) who tripped on his walking stick (there was a stone below the stick which rolled away) and fell resulting in a hip neck fracture.He underwent a total hip replacement and is now walking well.Fracture of the neck of the femur is a very important injury for many causes.It is frequent and the incidence is growing.The main causes of fractured neck of femur require an understanding of falls and osteoporosis.Patients with this injury often have many co-morbidities and the fracture has a large mortality rate.Treatment of this injury is often used as a model for management of acute problems in the elderly.CausesA hip neck fracture means a fracture of the proximal femur (proximal to 5 cm below the lesser trochanter ).Hip neck fractures are the most frequent reason for admission to an orthopedic trauma wardIntra-capsular fractures involve the femoral neck between the edge of the femoral head and insertion of the capsule of the hip joint.1.Around half of all hip fractures are intra-capsular.2.Intra-capsular fractures may disrupt the blood supply to the femoral head, leading to avascular necrosis (AVN).Extra-capsular trochanteric fractures (Distal to the insertion of the capsule, involving or between the trochanters)They are inter-trochanteric or peri-trochanteric and reverse oblique fractures and isolated trochanteric avulsion fractures.Isolated trochanteric avulsion fractures can occur from sudden violent force avulsing the insertion of gluteus medius from the greater trochanter, or iliopsoas from the lesser trochanter.Mechanism of the femur neck fracture is due to:1.The high energy in young patients2.The low energy falls in older patientsThe risk factors for a fractured neck of femur can be:1. Risk factors for falls and2. Risk factors for osteoporosis (some things e.g. alcohol, immobility may be risk factors for both).SymptomsAn elderly patient with pain in the hip following a fall must be assumed to have a fractured neck of femur until proved otherwise.Impacted and stress fracturesThere is slight pain in the groin or pain referred along the medial side of the thigh and kneeDisplaced fracturesThe leg is in external rotation and abduction, with shorteningDiagnosis of the cause of the fallIt is also important to diagnose the cause of the fall as there may be a treatable cause e.g. postural hypotension, cardiac arrhythmia.Diagnosis of the type of fractureIt is important to diagnose the type of fracture as this influences treatment.Any elderly person who has hip pain or pain in the legs, even without a history of a fall, should also have an X-ray of the hip.TreatmentED1.General workup CXR, intravenous access with intravenous infusion if indicated.2.Analgesia should be sufficient for the patient and should permit the movements needed for investigations and for rehabilitation.Intra-capsular fractures1.Surgery should be done within one day of admission.2.Undisplaced fractures require internal fixation with screws3.Displaced intra-capsular fractures should be treated by replacement of the femoral head with an arthroplasty, if the person is fit for the procedureExtra-capsular fractures1. Extra-capsular hip fractures are treated surgically unless there are medical contra-indications.2. They are usually treated by internal fixation but hip arthroplasty may be used (internal fixation may fail, especially for unstable fractures)TABLE OF CONTENTIntroductionChapter 1 Hip Neck FractureChapter 2 CausesChapter 3 SymptomsChapter 4 DiagnosisChapter 5 TreatmentChapter 6 PrognosisChapter 7 Hip OsteonecrosisChapter 8 FractureEpilogue
