Fracture of the proximal femur (intracapsular or extracapsular); high morbidity/mortality in the elderly.
Risk factors
- • Osteoporosis
- • Falls risk
- • Female, age
- • Steroids, smoking, alcohol
Clinical features
- • Hip / groin pain after fall
- • Inability to weight bear
- • Shortened, externally rotated leg
Investigations
- • Pelvic + lateral hip X-ray
- • MRI if X-ray normal but high suspicion
- • ECG, bloods, CXR, group & save
- • Cognitive assessment (AMTS / 4AT)
Management
- • Analgesia + fascia iliaca block
- • Optimise within 36 h to surgery
- • Intracapsular: hemiarthroplasty (low demand) / THR (fit, mobile)
- • Extracapsular: DHS (intertroch) / IM nail (subtroch)
- • Bone health: DEXA, calcium/vit D, bisphosphonate
- • Ortho-geriatric MDT, early mobilisation
Complications
- • AVN, non-union
- • Pressure sores, DVT/PE
- • Delirium, pneumonia
- • Loss of independence
Clinical pearls
- • NHFD: surgery <36 h is a quality target
- • Always plan secondary fracture prevention
Related in WardRound
Educational — verify locally.
