An intramedullary nail should be used to treat patients with a subtrochanteric fracture.Extramedullary implants such as a sliding hip screw should be used in preference to an intramedullary nail in patients with trochanteric fractures above and including the lesser trochanter.A proven femoral stem design rather than Austin Moore or Thompson stems and cemented implants should be used for arthroplasties.Total hip replacement rather than hemiarthroplasty for displaced intracapsular hip fracture if able to walk independently out of doors with no more than the use of a stick, not cognitively impaired, and medically fit for anaesthesia and the procedure.Replacement arthroplasty (total hip replacement or hemiarthroplasty) for displaced intracapsular hip fracture.The National Institute for Health and Care Excellence (NICE) recommends :.Displaced intracapsular fractures should be treated by replacement of the femoral head with an arthroplasty, if the person is fit for the procedure: internal fixation is associated with less initial operative trauma but has an increased risk of re-operation on the hip.Undisplaced fractures need internal fixation with screws (arthroplasty is considered for those patients who are less fit).Surgery should be performed within one day of admission.Early assessment for cognitive impairment and treatable comorbidities - eg, anaemia, volume depletion, electrolyte imbalance, acute confusional states, uncontrolled diabetes, uncontrolled heart failure, cardiac ischaemia, arrhythmia, chest infection.Non-steroidal anti-inflammatory drugs (NSAIDs) are not recommended.Analgesia should be adequate for the patient and should enable the movements necessary for investigations and for nursing care and rehabilitation.General workup including FBC and cross match, renal function, glucose, ECG and, if indicated, CXR, intravenous access with intravenous infusion if indicated.Garden IV: gross, often complete, displacement of the femoral head.Garden III: obvious complete fracture line with slight displacement and/or rotation of the femoral head.Garden II: trabeculae in line but a fracture line is visible from superior to inferior cortex.Garden I: trabeculae angulated, inferior cortex intact.Intracapsular neck of femur fractures are graded by various classifications, including Garden's classification :.If MRI is not available within 24 hours or is contra-indicated (eg, due to a pacemaker) then computerised tomography (CT) should be requested. Magnetic resonance imaging (MRI) should be performed if a hip fracture is suspected but AP pelvic and lateral hip X-rays don't show a fracture.It is used to determine the relationship of the head of the femur to the acetabulum. Shenton's line is a radiographic, curved line formed by the top of the obturator foramen and the inner side of the neck of the femur.Anteroposterior (AP) pelvic and lateral hip X-rays: may show disruption of trabeculae, inferior or superior cortices and abnormality of pelvic contours. ![]() In younger patients hip fractures are usually caused by high-energy trauma and are often associated with other serious injuries.Hip fractures can follow relatively minor trauma (eg, a fall, or a direct blow to the side of the hip) in the elderly, those with osteoporosis and those with metastatic disease.Isolated trochanteric avulsion fractures can result from sudden violent force avulsing the insertion of gluteus medius from the greater trochanter, or iliopsoas from the lesser trochanter.įractures below, but no more than 5 cm below, the lesser trochanter, ie involving the proximal femoral shaft, at, or just distal to, the trochanters.They include intertrochanteric or pertrochanteric and reverse oblique fractures and isolated trochanteric avulsion fractures.Intracapsular fractures may disrupt the blood supply to the femoral head, leading to avascular necrosis.ĭistal to the insertion of the capsule, involving or between the trochanters.Around half of all hip fractures are intracapsular.Involve the femoral neck between the edge of the femoral head and insertion of the capsule of the hip joint. Most second hip fractures occur within 48 months of the first. A second fracture of the contralateral hip carries even higher complications. Women experience 80% of hip fractures, and the average age of people who have a hip fracture is 80 years. ![]() Hip fractures cause significant morbidity and are associated with increased mortality. Hip fractures are the most common reason for admission to an orthopaedic trauma ward. A hip fracture means a fracture of the proximal femur (proximal to 5 cm below the lesser trochanter).
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