Materiały źródłowe

• #1 Hip Fracture: Broken Hip & Femur fracture – Best Treatment

  https://physiopretoria.co.za/conditions/hip-fracture

  A force that is stronger than your femur bone itself is needed to break it. Keeping in mind that the femur is the strongest and biggest bone in your body, you will need an immense force to cause a hip fracture. […] Your body will respond with an immediate and severe inflammatory reaction. All in the hopes of trying to heal the injured area. Inflammation will lead to swelling of the tissue around the broken bone and this will add to your pain. […] To have a broken hip is a serious medical emergency. It needs to be managed by an orthopaedic surgeon as soon as possible. […] Hip fractures can lead to serious complications like blood clots and fat embolisms due to bleeding and swelling. The top part of the femur that gets broken off will get cut off from circulation and will slowly start to die if the fracture isn’t fixed early enough. This is called avascular necrosis.

• #2 Hip Fracture Pathophysiology – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Group

  https://www.acibademhealthpoint.com/hip-fracture-pathophysiology/

  Hip fractures are complex injuries involving both biology and mechanics. We look into the hip’s anatomy to understand why it’s prone to break. Factors like bone strength and structure matter a lot in injury risk. […] We know hip fractures come from both weaker bones and outside forces. Getting older and having less dense bones makes fractures more likely. Some health issues and ways of living can also raise the chances of a hip injury. […] It’s really important to know why hip fractures happen. This helps us figure out how to stop them and treat them well. Mostly, these breaks come from bad bone health, like with osteoporosis, or from accidents. […] Low bone density is a big issue leading to hip fractures. This often comes from osteoporosis, where bones get weak and easy to break. This affects a lot of older people and causes many hip breaks because their bones are not as strong.

• #3 Hip Fractures – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/hip-fractures/

  A hip fracture is a break in the upper portion of the femur (thighbone). Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis. […] Most hip fractures result from low-energy falls in elderly patients who have weakened or osteoporotic bone. In these patients, even a simple twisting or tripping injury may lead to a fracture. […] In some cases, the bone may be so weak that the fracture occurs spontaneously while someone is walking or standing. In this instance, it is often said that the break occurs before the fall. Spontaneous fractures usually occur in the femoral neck. […] Displaced fractures of the femoral neck present a more difficult problem than nondisplaced fractures. The blood supply to the head of the femur comes through a structure called the posterior capsule. The posterior capsule is often injured with a displaced femoral neck fracture, so the fracture has less chance of healing.

• #4 Hip Fracture in the ED: Background, Skeletal Anatomy, Vascular Supply

  https://emedicine.medscape.com/article/825363-overview

  Fractures of the hip are relatively common in adults and often lead to devastating consequences. […] Most hip fractures occur in elderly individuals as a result of minimal trauma, such as a fall from standing height. […] High-velocity injuries are more difficult to treat and are associated with more complications than minor trauma injuries. […] A fracture results when these forces exceed the strength of the bone. […] Femoral neck fractures are rare in younger patients and more commonly seen in older adults, most often secondary to osteoporosis or osteomalacia. […] The incidence of avascular necrosis (AVN) is up to 15% in nondisplaced fractures and increases to nearly 90% with untreated, completely displaced fractures. […] Osteoporosis is the leading cause of hip fracture. […] The age-adjusted hazard ratio per standard deviation change in DXR score for hip fracture in the study was 2.52 and 2.08 for women and men, respectively.

• #5 Hip Fracture Pathophysiology – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Group

  https://www.acibademhealthpoint.com/hip-fracture-pathophysiology/

  Hip fractures happen for many reasons. Knowing how they occur helps in preventing, diagnosing, and treating them. […] The stress on bones is key to hip fracture issues. This stress can cause tiny cracks with repeated heavy use. […] The hip fracture’s pathophysiology is very complicated. It involves both biological and mechanical parts. When the hip gets injured, the body starts a healing process. […] Several biological factors kick in when a hip fracture happens. First, an inflammatory phase starts. This involves blood clots and cells that cause inflammation around the break. Next, granulation tissue forms. This tissue helps with new bone growth. […] After that, the reparative phase begins. In this phase, soft and hard calluses form. Cells that make bone and cartilage are very important here. They help create new bone. Lastly, the bone remodels. It changes some new bone into the original, strong bone.

• #6 Hip Fracture: Anatomy, Causes, and Consequences | IntechOpen

  https://www.intechopen.com/chapters/64065

  Fall-induced hip fracture is a major worldwide health problem among the elderly population. […] Hip fractures have several complications including medical and surgical treatment. A significant number of biomechanical models have been introduced to study hip fracture risk. The purpose of proposing the biomechanical models for predicting the hip fracture risk is to introduce prevention and protection activities that may reduce the number of hip fractures. For accurate prediction of hip fracture risk, the fracture procedure and the parameters that affect the risk of hip fracture should be well studied. […] Hip fracture is generally affected by hip anatomy, the applied forces to the hip, and bone mechanical properties. […] More than 90% of all hip fractures occur in falls as the femur is subjected to a high-level impact force.

• #7 Hip fracture – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hip-fracture/symptoms-causes/syc-20373468

  A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age. […] Risk increases because bones tend to weaken with age (osteoporosis). […] A hip fracture almost always requires surgical repair or replacement, followed by physical therapy. […] The risk of hip fracture can be increased if you have: Osteoporosis. This condition weakens bones and makes them more likely to break. […] Cortisone medications, such as prednisone, can weaken bones if taken long-term. […] Lack of calcium and vitamin D in the diet of young people lowers peak bone mass and increases risk of fracture later in life. […] Healthy lifestyle choices in early adulthood build a higher peak bone mass and reduce the risk of osteoporosis in later years. […] To avoid falls and to maintain healthy bone: Get enough calcium and vitamin D. […] Exercise to strengthen bones and improve balance.

• #8 Hip Fractures – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/hip-fractures/

  A hip fracture is a break in the upper portion of the femur (thighbone). Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis. […] Most hip fractures result from low-energy falls in elderly patients who have weakened or osteoporotic bone. In these patients, even a simple twisting or tripping injury may lead to a fracture. […] In some cases, the bone may be so weak that the fracture occurs spontaneously while someone is walking or standing. In this instance, it is often said that the break occurs before the fall. Spontaneous fractures usually occur in the femoral neck. […] Displaced fractures of the femoral neck present a more difficult problem than nondisplaced fractures. The blood supply to the head of the femur comes through a structure called the posterior capsule. The posterior capsule is often injured with a displaced femoral neck fracture, so the fracture has less chance of healing.

• #9 Hip Fractures – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/hip-fractures/

  Even if the fracture does heal, a condition called avascular necrosis may develop in the head of the femur. This causes damage to the bone cells, collapse of part of the femoral head, and subsequent arthritis. […] Femoral head fractures are rare; they account for less than 1% of all hip fractures. They usually result from a high-velocity event. Sometimes there may be an associated fracture of the hip joint socket.

• #10 Hip Fracture: Causes, Symptoms, and Treatment

  https://patient.info/bones-joints-muscles/hip-problems/hip-fracture

  A hip fracture is another term for a broken hip. Doctors sometimes call a hip fracture a femoral neck fracture or a fracture of the neck of femur. It is a common injury in older people, especially women, with underlying 'thinning’ of the bones (osteoporosis). […] 'Thinning’ of the bones (osteoporosis) is the leading cause of hip fracture. If you have osteoporosis you are more likely to fracture your hip when you fall. Osteoporosis means that your bones have become less dense and more fragile, so that less force is needed to break them. […] Hip fracture can also occur in younger people. In these cases, it is more likely to be caused by trauma such as a car crash or a fall from a significant height. The denser bones of younger people mean that greater force is needed to break a bone as large as the hip bone.

• #11 Hip Fractures – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/hip-fractures/

  A hip fracture is a break in the upper portion of the femur (thighbone). Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis. […] Most hip fractures result from low-energy falls in elderly patients who have weakened or osteoporotic bone. In these patients, even a simple twisting or tripping injury may lead to a fracture. […] In some cases, the bone may be so weak that the fracture occurs spontaneously while someone is walking or standing. In this instance, it is often said that the break occurs before the fall. Spontaneous fractures usually occur in the femoral neck. […] Displaced fractures of the femoral neck present a more difficult problem than nondisplaced fractures. The blood supply to the head of the femur comes through a structure called the posterior capsule. The posterior capsule is often injured with a displaced femoral neck fracture, so the fracture has less chance of healing.

• #12 A novel diagnostic sign of hip fracture mechanism in ground level falls: two case reports and review of the literature | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-6-136

  Most elderly hip fractures are the result of a ground level fall. […] Defining high risk falls and fracture mechanisms are important to develop successful hip fracture prevention programs. […] The fractures occurred as a result of unprotected ground level falls in a forward direction with initial impact to the knee. […] The physical finding of a small localized site of impact and/or contusion in the anterior aspect of the knee in both of these patients with radiographic evidence of an ipsilateral hip fracture would strongly suggest that a knee impact injury can transmit enough energy to the proximal femur by axial loading to result in the hip fracture. […] The physical finding described is a reliable indicator of this hip fracture mechanism. […] Investigators studying hip fracture mechanisms have concluded that the most common mechanism of hip fracture in the elderly is a sideways fall with lateral hip impact.

• #13 A novel diagnostic sign of hip fracture mechanism in ground level falls: two case reports and review of the literature | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-6-136

  The present series documents two cases of ground level falls in which both patients describe falling directly forward in an unprotected manner, with initial and isolated direct anterior knee impact. […] The only mechanism of injury to reasonably account for the hip fractures found in our two patients is an axial loading of the ipsilateral femur through direct knee impact. […] A recent study by Yamamoto et al. clarifies some of the various mechanisms of hip fracture in the elderly and investigates methods of fracture prevention. […] Their results show that a knee grounding fall caused a higher risk of hip fracture than the risk by a lateral impact on the greater trochanter. […] The physical finding of a small localized site of impact and/or contusion in an anterior knee location in both patients with radiologic evidence of an ipsilateral hip fracture would strongly suggest that a knee impact injury can transmit enough energy to the proximal femur by axial loading to result in the hip fracture. […] This physical finding (Knee Impact Sign), described herein, is a reliable indicator of this hip fracture mechanism.

• #14 Hip Fracture: Anatomy, Causes, and Consequences | IntechOpen

  https://www.intechopen.com/chapters/64065

  The main cause of hip fracture is falling, in particular falling in sideways direction, as it induces a high level of force on the femur. […] Hip fracture is usually caused by an applied force that exceeds the strength of the femur bone. […] Osteoporosis as a progressive bone disease, which is characterized by decreases in bone mass and density, has been identified as one of the main contributors of hip fracture. […] The increasing rate of hip fracture in the elderly is mainly associated with their slower reflex response and the inability to effectively use their arms to reduce the energy of the fall and low bone density of the proximal femur. […] The aim of accurately assessing hip fracture risk is to identify patients at high risk of hip fracture and to start timely prevention and protection measures to reduce the number of hip fractures.

• #15 Hip Fracture in the ED: Background, Skeletal Anatomy, Vascular Supply

  https://emedicine.medscape.com/article/825363-overview

  Fractures of the hip are relatively common in adults and often lead to devastating consequences. […] Most hip fractures occur in elderly individuals as a result of minimal trauma, such as a fall from standing height. […] High-velocity injuries are more difficult to treat and are associated with more complications than minor trauma injuries. […] A fracture results when these forces exceed the strength of the bone. […] Femoral neck fractures are rare in younger patients and more commonly seen in older adults, most often secondary to osteoporosis or osteomalacia. […] The incidence of avascular necrosis (AVN) is up to 15% in nondisplaced fractures and increases to nearly 90% with untreated, completely displaced fractures. […] Osteoporosis is the leading cause of hip fracture. […] The age-adjusted hazard ratio per standard deviation change in DXR score for hip fracture in the study was 2.52 and 2.08 for women and men, respectively.

• #16 The pathophysiology of osteoporotic hip fracture

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2322920/

  Osteoporotic hip fractures have a profound impact on the physical health and psychosocial wellbeing of patients. […] The causes of osteoporosis and hip fracture are, however, well characterised and offer multiple opportunities both for prevention and disease management. This narrative review considers the pathophysiology of osteoporosis with particular reference to fragility fractures of the hip. […] Although osteoporosis may be caused by multiple factors, all of these are thought to act by subverting the normal physiology of healthy bone. […] A number of risk factors for reduced BMD exert their effect through subversion of the remodelling process. Indeed, osteoporosis may be seen simply as a failure of bone deposition to match the rate of resorption. […] Glucocorticoids are, however, associated with greatly reduced BMD. They are the most frequent cause of secondary osteoporosis and as many as 50% of patients receiving long-term glucocorticoid therapy sustain a fragility fracture.

• #17 The pathophysiology of osteoporotic hip fracture

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2322920/

  These drugs exert their osteoporotic effects through a number of mechanisms. For example, they impair the replication and differentiation of osteoblasts, as well as induce apoptosis in mature osteoblasts. […] The bone-sparing properties of oestrogen explain why early menopause predisposes to low BMD and underlies the rationale for using hormone replacement therapy (HRT) to avert osteoporosis. […] Although menopause accounts for much of the association between age and osteoporosis, bone ageing occurs even before the menopause in many women. The actual aetiology of age-related bone loss is unknown, although it is understood to involve an imbalance in bone remodelling. […] A greater understanding of the pathophysiology of osteoporosis is likely to inform health promotion strategies aimed both at primary and secondary prevention of this disease.

• #18 The pathophysiology of osteoporotic hip fracture

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2322920/

  Osteoporotic hip fractures have a profound impact on the physical health and psychosocial wellbeing of patients. […] The causes of osteoporosis and hip fracture are, however, well characterised and offer multiple opportunities both for prevention and disease management. This narrative review considers the pathophysiology of osteoporosis with particular reference to fragility fractures of the hip. […] Although osteoporosis may be caused by multiple factors, all of these are thought to act by subverting the normal physiology of healthy bone. […] A number of risk factors for reduced BMD exert their effect through subversion of the remodelling process. Indeed, osteoporosis may be seen simply as a failure of bone deposition to match the rate of resorption. […] Glucocorticoids are, however, associated with greatly reduced BMD. They are the most frequent cause of secondary osteoporosis and as many as 50% of patients receiving long-term glucocorticoid therapy sustain a fragility fracture.

• #19 The pathophysiology of osteoporotic hip fracture

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2322920/

  These drugs exert their osteoporotic effects through a number of mechanisms. For example, they impair the replication and differentiation of osteoblasts, as well as induce apoptosis in mature osteoblasts. […] The bone-sparing properties of oestrogen explain why early menopause predisposes to low BMD and underlies the rationale for using hormone replacement therapy (HRT) to avert osteoporosis. […] Although menopause accounts for much of the association between age and osteoporosis, bone ageing occurs even before the menopause in many women. The actual aetiology of age-related bone loss is unknown, although it is understood to involve an imbalance in bone remodelling. […] A greater understanding of the pathophysiology of osteoporosis is likely to inform health promotion strategies aimed both at primary and secondary prevention of this disease.

• #20 Overview of common hip fractures in adults – UpToDate

  https://www.uptodate.com/contents/overview-of-common-hip-fractures-in-adults

  Disruption of the blood supply to the head and neck of the femur can impair fracture healing in these structures. […] An extracapsular vascular ring encircles the base of the femoral neck. This ring gives rise to feeder vessels (ascending cervical arteries) that run parallel to the femoral neck up to the femoral head. […] The foveal artery (a branch of the obturator artery) provides supplementary blood flow to the femoral head. It courses through the ligamentum teres into the fovea. However, the foveal artery alone is not thought to be adequate to meet the needs of the femoral head. […] The arrangement of its cancellous bone is oriented along the principal lines of stress. Most important of these arrangements are the primary medial trabeculae (which resist compression) and the primary lateral trabeculae (which resist tension). These structures enable the bone to endure the strong forces exerted across the proximal femur.

• #21 Overview of common hip fractures in adults – UpToDate

  https://www.uptodate.com/contents/overview-of-common-hip-fractures-in-adults

  Disruption of the blood supply to the head and neck of the femur can impair fracture healing in these structures. […] An extracapsular vascular ring encircles the base of the femoral neck. This ring gives rise to feeder vessels (ascending cervical arteries) that run parallel to the femoral neck up to the femoral head. […] The foveal artery (a branch of the obturator artery) provides supplementary blood flow to the femoral head. It courses through the ligamentum teres into the fovea. However, the foveal artery alone is not thought to be adequate to meet the needs of the femoral head. […] The arrangement of its cancellous bone is oriented along the principal lines of stress. Most important of these arrangements are the primary medial trabeculae (which resist compression) and the primary lateral trabeculae (which resist tension). These structures enable the bone to endure the strong forces exerted across the proximal femur.

• #22 Hip Fractures – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/hip-fractures/

  A hip fracture is a break in the upper portion of the femur (thighbone). Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis. […] Most hip fractures result from low-energy falls in elderly patients who have weakened or osteoporotic bone. In these patients, even a simple twisting or tripping injury may lead to a fracture. […] In some cases, the bone may be so weak that the fracture occurs spontaneously while someone is walking or standing. In this instance, it is often said that the break occurs before the fall. Spontaneous fractures usually occur in the femoral neck. […] Displaced fractures of the femoral neck present a more difficult problem than nondisplaced fractures. The blood supply to the head of the femur comes through a structure called the posterior capsule. The posterior capsule is often injured with a displaced femoral neck fracture, so the fracture has less chance of healing.

• #23 Hip Fractures – Injuries and Poisoning – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/injuries-and-poisoning/fractures/hip-fractures

  Femoral neck hip fractures are particularly problematic because the fracture often disrupts the blood supply to the head of the bone. Without a good blood supply, the bone cannot grow back together, and it may eventually collapse and die (called osteonecrosis). Severe, painful arthritis may develop. […] Intertrochanteric hip fractures rarely interrupt the blood supply to the head of the femur. The broken surface of the bone may bleed but not usually enough to cause serious problems. These fractures usually result from a fall or direct blow.

• #24 Hip Fracture in the ED: Background, Skeletal Anatomy, Vascular Supply

  https://emedicine.medscape.com/article/825363-overview

  Fractures of the hip are relatively common in adults and often lead to devastating consequences. […] Most hip fractures occur in elderly individuals as a result of minimal trauma, such as a fall from standing height. […] High-velocity injuries are more difficult to treat and are associated with more complications than minor trauma injuries. […] A fracture results when these forces exceed the strength of the bone. […] Femoral neck fractures are rare in younger patients and more commonly seen in older adults, most often secondary to osteoporosis or osteomalacia. […] The incidence of avascular necrosis (AVN) is up to 15% in nondisplaced fractures and increases to nearly 90% with untreated, completely displaced fractures. […] Osteoporosis is the leading cause of hip fracture. […] The age-adjusted hazard ratio per standard deviation change in DXR score for hip fracture in the study was 2.52 and 2.08 for women and men, respectively.

• #25 Hip Fracture: Diagnosis, Treatment, and Secondary Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0615/p945.html

  The timing of surgery may affect the eventual outcome. Early surgery (within 24 to 48 hours) is prudent. This allows earlier mobilization and rehabilitation, which speeds functional recovery and decreases the risk of pneumonia, skin breakdown, deep venous thrombosis, and urinary tract infections. […] Displaced fractures have an increased risk of avascular necrosis. Therefore, periodic radiography should be performed following surgery.

• #26 Hip Fracture: Diagnosis, Treatment, and Secondary Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0615/p945.html

  The intertrochanteric region contains a large amount of cancellous bone and an adequate blood supply. As a result, fractures in this region typically heal well with open reduction and internal fixation, which involves surgery to reduce the displaced bone, followed by internal fixation of the fracture with plates or screws. […] Subtrochanteric fractures, however, have an increased need for intramedullary rods or nails (impact devices) and have a higher rate of impact failure, mainly because of the high stresses on this part of the femur. […] The femoral neck region has a thin periosteum, little cancellous bone, and a relatively poor blood supply. Consequently, fractures in the intracapsular region have a higher incidence of avascular necrosis, nonunion or malunion, and degenerative changes.

• #27 Hip Fractures – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/hip-fractures/

  Even if the fracture does heal, a condition called avascular necrosis may develop in the head of the femur. This causes damage to the bone cells, collapse of part of the femoral head, and subsequent arthritis. […] Femoral head fractures are rare; they account for less than 1% of all hip fractures. They usually result from a high-velocity event. Sometimes there may be an associated fracture of the hip joint socket.

• #28 Hip Fractures – Injuries and Poisoning – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/injuries-and-poisoning/fractures/hip-fractures

  Femoral neck hip fractures are particularly problematic because the fracture often disrupts the blood supply to the head of the bone. Without a good blood supply, the bone cannot grow back together, and it may eventually collapse and die (called osteonecrosis). Severe, painful arthritis may develop. […] Intertrochanteric hip fractures rarely interrupt the blood supply to the head of the femur. The broken surface of the bone may bleed but not usually enough to cause serious problems. These fractures usually result from a fall or direct blow.

• #29 Hip Fracture: Diagnosis, Treatment, and Secondary Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0615/p945.html

  The intertrochanteric region contains a large amount of cancellous bone and an adequate blood supply. As a result, fractures in this region typically heal well with open reduction and internal fixation, which involves surgery to reduce the displaced bone, followed by internal fixation of the fracture with plates or screws. […] Subtrochanteric fractures, however, have an increased need for intramedullary rods or nails (impact devices) and have a higher rate of impact failure, mainly because of the high stresses on this part of the femur. […] The femoral neck region has a thin periosteum, little cancellous bone, and a relatively poor blood supply. Consequently, fractures in the intracapsular region have a higher incidence of avascular necrosis, nonunion or malunion, and degenerative changes.

• #30 Hip Fracture: Diagnosis, Treatment, and Secondary Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0615/p945.html

  Hip fractures cause significant morbidity and are associated with increased mortality. […] Most hip fractures are associated with a fall, although other risk factors include decreased bone mineral density, reduced level of activity, and chronic medication use. […] The modifiable risk factors for hip fracture include falls, decreased bone mineral density, reduced level of activity, and chronic medication use. A fall is the most significant risk factor for hip fracture, with 90% of fractures associated with a fall. […] A bone mineral density T-score less than 2.5, as measured by dual energy x-ray absorptiometry, is associated with an increased risk of fractures. […] Hip fractures are classified by location for prognostic implications. The two categories are extracapsular (intertrochanteric and subtrochanteric) and intracapsular (femoral head and neck); these are summarized in Table 2.

• #31 Hip fractures – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hip-fractures/

  Hip fractures are classified as intracapsular (femoral head, femoral neck) or extracapsular (intertrochanteric, trochanteric, or subtrochanteric). […] Hip fractures in older adults are typically low-impact injuries and are often associated with osteoporosis. […] Chronic overburdening can lead to insufficiency fractures, which can then completely fracture spontaneously. […] Pathological fracture due to metastases. […] Osteoporosis (especially postmenopausal women and older individuals) is a significant risk factor. […] Older adults have higher morbidity and mortality following a hip fracture because of coincident frailty and/or other complex medical problems. […] Hip fractures, especially fractures of the femoral head, can be associated with a hip dislocation. […] Hip fracture-dislocations require urgent orthopedic intervention; the decision to perform an urgent closed reduction or open reduction depends on fracture and dislocation characteristics. […] Osteonecrosis of the femoral head is a common severe complication. […] Intracapsular fractures (e.g., femoral head and neck fractures) have an increased rate of nonunion which leads to AVN. […] Hip fractures have a high rate of associated morbidity and mortality in older adults.

• #32 Neck of femur fracture | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/neck-of-femur-fracture-1?lang=us

  Femoral neck fractures are a subset of proximal femoral fractures. The femoral neck is the weakest part of the femur. […] Since disruption of blood supply to the femoral head is dependent on the type of fracture and causes significant morbidity, the diagnosis and classification of these fractures is important. […] In elderly patients, the mechanism of injury varies from falls directly onto the hip to a twisting mechanism in which the patients foot is planted and the body rotates. There is generally deficient elastic resistance in the fractured bone. […] The mechanism in young patients is predominantly axial loading during high force trauma, with an abducted hip during injury causing a neck of femur fracture and an adducted hip causing a hip fracture-dislocation.

• #33

  https://www.orthobullets.com/trauma/1037/femoral-neck-fractures

  Femoral neck fractures are common injuries to the proximal femur associated with increased risk of avascular necrosis, and high levels of patient morbidity and mortality. […] Pathophysiology healing potential femoral neck is intracapsular, bathed in synovial fluid lacks periosteal layer callus formation limited, which affects healing. […] Mechanism high energy in young patients low energy falls in older patients.

• #34 Hip Fractures – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/hip-fractures/

  A hip fracture is a break in the upper portion of the femur (thighbone). Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis. […] Most hip fractures result from low-energy falls in elderly patients who have weakened or osteoporotic bone. In these patients, even a simple twisting or tripping injury may lead to a fracture. […] In some cases, the bone may be so weak that the fracture occurs spontaneously while someone is walking or standing. In this instance, it is often said that the break occurs before the fall. Spontaneous fractures usually occur in the femoral neck. […] Displaced fractures of the femoral neck present a more difficult problem than nondisplaced fractures. The blood supply to the head of the femur comes through a structure called the posterior capsule. The posterior capsule is often injured with a displaced femoral neck fracture, so the fracture has less chance of healing.

• #35

  https://www.orthobullets.com/trauma/1038/intertrochanteric-fractures

  Intertrochanteric Fractures are common extracapsular fractures of the proximal femur at the level of the greater and lesser trochanter that are most commonly seen following ground-level falls in the elderly population. […] Pathophysiology […] mechanism […] elderly […] low energy falls in osteoporotic patients […] young […] high energy trauma.

• #36 Hip Fracture: Diagnosis, Treatment, and Secondary Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0615/p945.html

  The intertrochanteric region contains a large amount of cancellous bone and an adequate blood supply. As a result, fractures in this region typically heal well with open reduction and internal fixation, which involves surgery to reduce the displaced bone, followed by internal fixation of the fracture with plates or screws. […] Subtrochanteric fractures, however, have an increased need for intramedullary rods or nails (impact devices) and have a higher rate of impact failure, mainly because of the high stresses on this part of the femur. […] The femoral neck region has a thin periosteum, little cancellous bone, and a relatively poor blood supply. Consequently, fractures in the intracapsular region have a higher incidence of avascular necrosis, nonunion or malunion, and degenerative changes.

• #37 Hip Fractures – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/hip-fractures/

  Even if the fracture does heal, a condition called avascular necrosis may develop in the head of the femur. This causes damage to the bone cells, collapse of part of the femoral head, and subsequent arthritis. […] Femoral head fractures are rare; they account for less than 1% of all hip fractures. They usually result from a high-velocity event. Sometimes there may be an associated fracture of the hip joint socket.

• #38 Types of Hip & Pelvic Fractures | NYU Langone Health

  https://nyulangone.org/conditions/hip-pelvic-fractures/types

  Hip and pelvic fractures occur most commonly in people older than age 60 as a result of falls. Postmenopausal women who have osteoporosis, a condition that weakens bones, are most vulnerable. […] Depending on the cause of a fracture, it may occur in addition to injuries to surrounding muscles, tendons, ligaments, blood vessels, and nerves. Some of these soft tissues pass through openings in the pelvic bones and are especially vulnerable to injury if the pelvis is fractured. […] Hip and pelvic fractures require immediate treatment to prevent permanent damage to the bone or surrounding soft tissues. […] Many fractures of the femoral head are associated with a dislocated hip, in which the femur is pulled out of the acetabular socket. In some instances, the femoral head is displaced with such force that the femoral head cracks or breaks. This type of fracture is usually the result of a high-impact injury such as a car crash.

• #39 Types of Hip & Pelvic Fractures | NYU Langone Health

  https://nyulangone.org/conditions/hip-pelvic-fractures/types

  In people with osteoporosis, a type of stress fracture called an insufficiency fracture may develop in the femoral head. An insufficiency fracture occurs when weakened bones crack under the stress of everyday movements, such as walking or climbing stairs. […] Stress fractures in a pelvic bone usually develop as a result of repetitive, high-impact activity that puts stress on the pelvis, such as long-distance running or ballet. It often affects people who quickly increase the duration and intensity of a physical activity without gradually building up endurance. […] In people with osteoporosis, insufficiency fractures in the pelvis may develop as the result of everyday movements.

• #40 Understanding the pathogenesis of hip fracture in the elderly, osteoporotic theory is not reflected in the outcome of prevention programmes

  https://www.wjgnet.com/2218-5836/full/v7/i4/218.htm

  Understanding the pathogenesis of hip fracture in the elderly, osteoporotic theory is not reflected in the outcome of prevention programmes. […] Hip fractures are an acute and worsening public health problem. They mainly affect elderly people, a population group that is highly vulnerable to disease and accidents, and to falls in particular. Although it has been suggested that osteoporosis is the cause of hip fractures, they mainly occur after a fall has been suffered. The underlying causes of a fall are not related to osteoporosis, although pharmaceutical companies have coined the term osteoporotic fracture for hip fractures in the elderly. […] Falls are known to be the main cause of hip fracture. However, this pathology is commonly held to be closely related to osteoporosis. The pharmaceutics industry has coined the term osteoporotic fracture for any fracture suffered by an elderly person. Although all elderly people do indeed present osteoporosis, among other aspects of their health status, they may also be affected by heart disease, stroke or ocular or inner-ear balance problems, any one of which may provoke a fall. However, the fracture is never called an ophthalmic fracture or a labyrinth fracture.

• #41 Understanding the pathogenesis of hip fracture in the elderly, osteoporotic theory is not reflected in the outcome of prevention programmes

  https://www.wjgnet.com/2218-5836/full/v7/i4/218.htm

  Since osteoporosis alone never provokes a fall, and as a fall is the main antecedent of a hip fracture, there must be some mismatch in the assumption of causality between osteoporosis and hip fracture, i.e., in the pathogenesis of this condition. Osteoporosis only helps to fracture a bone with less energy than non-osteoporotic bone. […] The oral intake of vitamin D, with or without calcium, is the classical treatment for osteoporosis. Nonetheless, low plasma 25-hydroxy vitamin D concentration is associated with high arterial blood pressure and the risk of hypertension, and therefore a constant therapy of vitamin D, either alone or combined with calcium, for the prevention and treatment of osteoporosis, in the absence of explicit risk factors for vitamin D deficiency, appears to be inappropriate.

• #42 Understanding the pathogenesis of hip fracture in the elderly, osteoporotic theory is not reflected in the outcome of prevention programmes

  https://www.wjgnet.com/2218-5836/full/v7/i4/218.htm

  Understanding the pathogenesis of hip fracture in the elderly, osteoporotic theory is not reflected in the outcome of prevention programmes. […] Hip fractures are an acute and worsening public health problem. They mainly affect elderly people, a population group that is highly vulnerable to disease and accidents, and to falls in particular. Although it has been suggested that osteoporosis is the cause of hip fractures, they mainly occur after a fall has been suffered. The underlying causes of a fall are not related to osteoporosis, although pharmaceutical companies have coined the term osteoporotic fracture for hip fractures in the elderly. […] Falls are known to be the main cause of hip fracture. However, this pathology is commonly held to be closely related to osteoporosis. The pharmaceutics industry has coined the term osteoporotic fracture for any fracture suffered by an elderly person. Although all elderly people do indeed present osteoporosis, among other aspects of their health status, they may also be affected by heart disease, stroke or ocular or inner-ear balance problems, any one of which may provoke a fall. However, the fracture is never called an ophthalmic fracture or a labyrinth fracture.

• #43 Understanding the pathogenesis of hip fracture in the elderly, osteoporotic theory is not reflected in the outcome of prevention programmes

  https://www.wjgnet.com/2218-5836/full/v7/i4/218.htm

  Mineralisation deficit has also been proposed as a cause of bone weakness making elderly persons liable to suffer an osteoporotic hip fracture. But according to recent studies, the problem of mineralisation in elderly people is not one of a regular decrease of calcium in the bone, but rather the irregular distribution of its mineralisation. […] Therefore, this spatial heterogeneity of elastic coefficients of bone tissue has consequences for bone as an organ. […] Recent research findings have further reinforced the hypothesis that hypermineralisation and the heterogeneity of mineralisation patterns are at the root of bone fragility. […] If osteoporosis were the cause of hip fracture, then by treating osteoporosis many fractures could be prevented. However, as the real causal framework is different, the following questions (and answers) arise. What actually provokes a fracture? In many cases, a fall; and what provokes a fall? In many cases, a sensory deficit.

• #44 Understanding the pathogenesis of hip fracture in the elderly, osteoporotic theory is not reflected in the outcome of prevention programmes

  https://www.wjgnet.com/2218-5836/full/v7/i4/218.htm

  Mineralisation deficit has also been proposed as a cause of bone weakness making elderly persons liable to suffer an osteoporotic hip fracture. But according to recent studies, the problem of mineralisation in elderly people is not one of a regular decrease of calcium in the bone, but rather the irregular distribution of its mineralisation. […] Therefore, this spatial heterogeneity of elastic coefficients of bone tissue has consequences for bone as an organ. […] Recent research findings have further reinforced the hypothesis that hypermineralisation and the heterogeneity of mineralisation patterns are at the root of bone fragility. […] If osteoporosis were the cause of hip fracture, then by treating osteoporosis many fractures could be prevented. However, as the real causal framework is different, the following questions (and answers) arise. What actually provokes a fracture? In many cases, a fall; and what provokes a fall? In many cases, a sensory deficit.

• #45 Understanding the pathogenesis of hip fracture in the elderly, osteoporotic theory is not reflected in the outcome of prevention programmes

  https://www.wjgnet.com/2218-5836/full/v7/i4/218.htm

  Since hip fracture is usually caused by a fall, by identifying the population with a propensity to suffer a fall, i.e., those with a sensory or cognitive problem aggravating the risk of a fall, and then providing proper treatment for such problems, both falls and hip fractures could be prevented. […] New findings in the fields of the human genome, transcriptome and metabolomics, if appropriately addressed, would reveal the susceptibility of elderly people to falls and thus open the way to preventing many hip fractures.

• #46 Overview of common hip fractures in adults – UpToDate

  https://www.uptodate.com/contents/overview-of-common-hip-fractures-in-adults

  Disruption of the blood supply to the head and neck of the femur can impair fracture healing in these structures. […] An extracapsular vascular ring encircles the base of the femoral neck. This ring gives rise to feeder vessels (ascending cervical arteries) that run parallel to the femoral neck up to the femoral head. […] The foveal artery (a branch of the obturator artery) provides supplementary blood flow to the femoral head. It courses through the ligamentum teres into the fovea. However, the foveal artery alone is not thought to be adequate to meet the needs of the femoral head. […] The arrangement of its cancellous bone is oriented along the principal lines of stress. Most important of these arrangements are the primary medial trabeculae (which resist compression) and the primary lateral trabeculae (which resist tension). These structures enable the bone to endure the strong forces exerted across the proximal femur.

• #47 Mechanisms and Causes of Osteoporotic Hip Fractures in Elderly Patients – Turkish Journal of Osteoporosis

  https://www.turkosteoporozdergisi.org/articles/mechanisms-and-causes-of-osteoporotic-hip-fractures-in-elderly-patients/doi/tod.galenos.2019.05914

  Objective: To investigate the causes and occurrence mechanisms of osteoporotic hip fractures in elderly patients in Turkish society. […] Most patients with hip fracture over the age of 75 are low weight and living with caregivers. Most fractures occur via balance disturbances without any environmental factors and the majority of the patients fall on one side, not to the front or back. […] The fractures occurred most often at home via balance disturbances, without any associated environmental factors, and the majority of the patients fell on one side. […] Body weight is an important factor in the occurrence of an osteoporotic hip fracture after falling down. […] In our study, 49% of the patients were underweight, while only 3% were overweight or obese. […] The majority of the patients (94%) in our study fell to one side on their hips; therefore, we believe that, if it is possible, changing the direction of the fall by using walking assistant may be effective in decreasing the hip fracture rate.

• #48 Mechanisms and Causes of Osteoporotic Hip Fractures in Elderly Patients – Turkish Journal of Osteoporosis

  https://www.turkosteoporozdergisi.org/articles/mechanisms-and-causes-of-osteoporotic-hip-fractures-in-elderly-patients/doi/tod.galenos.2019.05914

  Those patients with poor health statuses are more prone to osteoporotic hip fractures. Environmental changes, such as eliminating floor coverings and internal steps, and using shower and toilet railings, may seem to be useful but environmental factors have minimal effects on osteoporotic hip fractures, so these practices will not be beneficial. Changing the direction of the fall, educating the patients accompanying relatives, and modifying the patients clothes and floor materials to reduce the impact energy during a fall may help to reduce the incidence of osteoporotic hip fractures.

• #49 Mechanisms and Causes of Osteoporotic Hip Fractures in Elderly Patients – Turkish Journal of Osteoporosis

  https://www.turkosteoporozdergisi.org/articles/mechanisms-and-causes-of-osteoporotic-hip-fractures-in-elderly-patients/doi/tod.galenos.2019.05914

  Objective: To investigate the causes and occurrence mechanisms of osteoporotic hip fractures in elderly patients in Turkish society. […] Most patients with hip fracture over the age of 75 are low weight and living with caregivers. Most fractures occur via balance disturbances without any environmental factors and the majority of the patients fall on one side, not to the front or back. […] The fractures occurred most often at home via balance disturbances, without any associated environmental factors, and the majority of the patients fell on one side. […] Body weight is an important factor in the occurrence of an osteoporotic hip fracture after falling down. […] In our study, 49% of the patients were underweight, while only 3% were overweight or obese. […] The majority of the patients (94%) in our study fell to one side on their hips; therefore, we believe that, if it is possible, changing the direction of the fall by using walking assistant may be effective in decreasing the hip fracture rate.

• #50 Bisphosphonate-related atypical femoral fracture: Managing a rare but serious complication | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/85/11/885

  The mechanism by which bisphosphonates increase the risk of atypical femoral fracture is not clear. These drugs work by suppressing bone turnover; however, in theory, prolonged use could suppress it too much and increase bone fragility. […] One hypothesis is that bisphosphonates impair the toughening of cortical bone, an important barrier to clinical fracture. This is supported by a study that found bisphosphonate users with atypical femoral fracture had deficits in intrinsic and extrinsic bone toughness, perhaps due to treatment-related increases in matrix mineralization. […] Although this study and others showed an increase in matrix mineralization and reduced mineralization heterogeneity with bisphosphonate use, it is unclear whether such changes contributed to reduced toughness or to atypical femoral fracture.

• #51 Mechanisms found to explain atypical femoral fractures | Cornell Chronicle

  https://news.cornell.edu/stories/2017/07/mechanisms-found-explain-atypical-femoral-fractures

  Radiograph imaging showing morphology of a typical fragility fracture of the hip (A), compared with an atypical femoral fracture, or AFF (B). The nature of the AFF indicates a brittle fracture process, possibly due to excess mineralization of the bone. […] Prolonged use of these drugs can alter the composition of bone, making it more brittle and more susceptible to a rare but serious form of fracture. […] The testing pointed to a couple of contributing factors: Bisphosphonate-treated women with AFF had bone that was harder and more mineralized than bisphosphonate-treated women with typical osteoporotic fractures. […] If resorption is slowed by bisphosphonates, the remodeling process is also affected. The result: The existing bone ages and gets brittle over time. […] The other unforeseen side effect to long-term bisphosphonate use involves crack-deflection the resurfaced bones ability to stop a microscopic crack from propagating, which can lead to a break. […] As you increase the mineralization, you may tend to lose that natural variation. […] Our work explains some of the underlying mechanisms of AFFs and can inform the refinement of dosing schedules for patients at risk of fragility fractures.

• #52 Bisphosphonate-related atypical femoral fracture: Managing a rare but serious complication | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/85/11/885

  The mechanism by which bisphosphonates increase the risk of atypical femoral fracture is not clear. These drugs work by suppressing bone turnover; however, in theory, prolonged use could suppress it too much and increase bone fragility. […] One hypothesis is that bisphosphonates impair the toughening of cortical bone, an important barrier to clinical fracture. This is supported by a study that found bisphosphonate users with atypical femoral fracture had deficits in intrinsic and extrinsic bone toughness, perhaps due to treatment-related increases in matrix mineralization. […] Although this study and others showed an increase in matrix mineralization and reduced mineralization heterogeneity with bisphosphonate use, it is unclear whether such changes contributed to reduced toughness or to atypical femoral fracture.

• #53 Mechanisms found to explain atypical femoral fractures | Cornell Chronicle

  https://news.cornell.edu/stories/2017/07/mechanisms-found-explain-atypical-femoral-fractures

  Radiograph imaging showing morphology of a typical fragility fracture of the hip (A), compared with an atypical femoral fracture, or AFF (B). The nature of the AFF indicates a brittle fracture process, possibly due to excess mineralization of the bone. […] Prolonged use of these drugs can alter the composition of bone, making it more brittle and more susceptible to a rare but serious form of fracture. […] The testing pointed to a couple of contributing factors: Bisphosphonate-treated women with AFF had bone that was harder and more mineralized than bisphosphonate-treated women with typical osteoporotic fractures. […] If resorption is slowed by bisphosphonates, the remodeling process is also affected. The result: The existing bone ages and gets brittle over time. […] The other unforeseen side effect to long-term bisphosphonate use involves crack-deflection the resurfaced bones ability to stop a microscopic crack from propagating, which can lead to a break. […] As you increase the mineralization, you may tend to lose that natural variation. […] Our work explains some of the underlying mechanisms of AFFs and can inform the refinement of dosing schedules for patients at risk of fragility fractures.

• #54 Elderly patients with concurrent hip fracture and lower respiratory tract infection: the pathogens and prognosis over different bedridden periods | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02399-1

  Elderly patients who experience hip fractures often become bedridden and are at risk of developing lower respiratory tract infections. […] Prolonged bed rest in patients led to an increase in hospitalization time, mortality rates, and decreased serum albumin levels. […] Elderly hip fracture patients with prolonged bedridden time had an increased chance of opportunistic pulmonary infection and decreased nutritional status. […] The correlation analysis showed that the longer bedridden time was correlated with lower ALB. […] Correlation analysis showed that the longer bedridden time was positively correlated with higher fungal infections and mixed infections as well as more diversified pathogenic strains. […] The independent risk factors related to the prognosis of the disease were the use of glucocorticoids during the anti-infective period, the prolongation of bedridden time, and low serum albumin levels.

• #55 Elderly patients with concurrent hip fracture and lower respiratory tract infection: the pathogens and prognosis over different bedridden periods | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02399-1

  Elderly patients who experience hip fractures often become bedridden and are at risk of developing lower respiratory tract infections. […] Prolonged bed rest in patients led to an increase in hospitalization time, mortality rates, and decreased serum albumin levels. […] Elderly hip fracture patients with prolonged bedridden time had an increased chance of opportunistic pulmonary infection and decreased nutritional status. […] The correlation analysis showed that the longer bedridden time was correlated with lower ALB. […] Correlation analysis showed that the longer bedridden time was positively correlated with higher fungal infections and mixed infections as well as more diversified pathogenic strains. […] The independent risk factors related to the prognosis of the disease were the use of glucocorticoids during the anti-infective period, the prolongation of bedridden time, and low serum albumin levels.

• #56 Elderly patients with concurrent hip fracture and lower respiratory tract infection: the pathogens and prognosis over different bedridden periods | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02399-1

  With the prolongation of bedridden time, the pathogens of the lower respiratory changes with following characteristics: (1) There is an increase in bacterial species, mainly the G bacilli, and fungal species. (2) An increase in multidrug-resistant and extensively drug-resistant G bacilli is observed. […] Therefore, glucocorticoids should be used with caution in elderly patients with hip fracture and pulmonary infection, particularly in those suspected of having opportunistic infections or bacteremia.

• #57 Elderly patients with concurrent hip fracture and lower respiratory tract infection: the pathogens and prognosis over different bedridden periods | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02399-1

  Elderly patients who experience hip fractures often become bedridden and are at risk of developing lower respiratory tract infections. […] Prolonged bed rest in patients led to an increase in hospitalization time, mortality rates, and decreased serum albumin levels. […] Elderly hip fracture patients with prolonged bedridden time had an increased chance of opportunistic pulmonary infection and decreased nutritional status. […] The correlation analysis showed that the longer bedridden time was correlated with lower ALB. […] Correlation analysis showed that the longer bedridden time was positively correlated with higher fungal infections and mixed infections as well as more diversified pathogenic strains. […] The independent risk factors related to the prognosis of the disease were the use of glucocorticoids during the anti-infective period, the prolongation of bedridden time, and low serum albumin levels.

• #58 Elderly patients with concurrent hip fracture and lower respiratory tract infection: the pathogens and prognosis over different bedridden periods | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02399-1

  With the prolongation of bedridden time, the pathogens of the lower respiratory changes with following characteristics: (1) There is an increase in bacterial species, mainly the G bacilli, and fungal species. (2) An increase in multidrug-resistant and extensively drug-resistant G bacilli is observed. […] Therefore, glucocorticoids should be used with caution in elderly patients with hip fracture and pulmonary infection, particularly in those suspected of having opportunistic infections or bacteremia.

• #59 Hip Fractures in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0201/p537.html

  The distinction between intracapsular and extracapsular fracture has prognostic value. For example, early detection of intracapsular fractures is especially important, because these fractures are prone to complications for two primary reasons. First, disruption of the blood supply to the femoral head frequently occurs and can lead to avascular necrosis. Second, the head fragment of the fracture is often a shell containing fragile cancellous bone that provides poor anchorage for a fixation device, a situation that often increases the possibility of nonunion or malunion.20,21,27 […] Most patients with hip fracture require surgical reduction and internal fixation. However, the choice of surgical procedure depends on the type of fracture, the preference of the orthopedic surgeon, the severity of the injury, the age of the patient, the presence or absence of comorbid conditions (e.g., osteoporosis, hip joint osteoarthritis), and the prognosis for recovery during rehabilitation.21 For example, extracapsular intertrochanteric fractures are typically repaired with surgical reduction and internal fixation. In contrast, treatments for intracapsular femoral neck fractures vary from internal fixation to hemiarthroplasty to total hip replacement, depending on the severity of the fracture, the stability of the joint, the patient’s condition, and the surgeon’s preference.21,27

• #60 Hip Fracture Diagnosis, Treatments & Recovery | Reno Orthopedic Center

  https://www.renoortho.com/specialties/center-for-fracture-trauma/hip-fracture/

  Hip fractures are generally treated with surgery. Depending on the location and stability of the fracture, your doctor will develop a personalized treatment plan according to your age, physical condition and medical history. […] Very few fractured hips in adults are treated without surgery. […] Without surgery, most patients with a broken hip develop bed sores, pneumonia, recurrent urinary tract infections and experience continued pain. […] Surgeons like to fix fractured hips as soon as possible. […] The type of fracture determines the type of surgery that is required. […] Hip fractures that occur in the femoral neck may require surgery depending on the location of the break, whether the broken bones are out of place (displaced) and the severity of the fracture. […] Nondisplaced femoral neck fractures can be treated with 3 screws placed through small incisions.

• #61 Hip Fractures in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0201/p537.html

  The distinction between intracapsular and extracapsular fracture has prognostic value. For example, early detection of intracapsular fractures is especially important, because these fractures are prone to complications for two primary reasons. First, disruption of the blood supply to the femoral head frequently occurs and can lead to avascular necrosis. Second, the head fragment of the fracture is often a shell containing fragile cancellous bone that provides poor anchorage for a fixation device, a situation that often increases the possibility of nonunion or malunion.20,21,27 […] Most patients with hip fracture require surgical reduction and internal fixation. However, the choice of surgical procedure depends on the type of fracture, the preference of the orthopedic surgeon, the severity of the injury, the age of the patient, the presence or absence of comorbid conditions (e.g., osteoporosis, hip joint osteoarthritis), and the prognosis for recovery during rehabilitation.21 For example, extracapsular intertrochanteric fractures are typically repaired with surgical reduction and internal fixation. In contrast, treatments for intracapsular femoral neck fractures vary from internal fixation to hemiarthroplasty to total hip replacement, depending on the severity of the fracture, the stability of the joint, the patient’s condition, and the surgeon’s preference.21,27

• #62 Hip Fractures – Zero To Finals

  https://zerotofinals.com/surgery/orthopaedics/hipfractures/

  Hip fractures are an important topic in trauma and orthopaedics. They are common and lead to significant morbidity and mortality. The 30-day mortality is 5-10%. Half of patients become less independent after a hip fracture. […] Increasing age and osteoporosis are major risk factors for hip fractures. Females are affected more often than males. […] Due to the morbidity and mortality with hip fractures, they are generally prioritised on the trauma list with the aim to perform surgery within 48 hours. […] The head of the femur has a retrograde blood supply. The medial and lateral circumflex femoral arteries join the femoral neck just proximal to the intertrochanteric line. Branches of this artery run along the surface of the femoral neck, within the capsule, towards the femoral head. They provide the only blood supply to the femoral head. A fracture of the intra-capsular neck of the femur can damage these blood vessels, removing the blood supply to the femoral head, leading to avascular necrosis. Therefore, patients with a displaced intra-capsular fracture need to have the femoral head replaced with a hemiarthroplasty or total hip replacement.

• #63 Hip Fracture Diagnosis, Treatments & Recovery | Reno Orthopedic Center

  https://www.renoortho.com/specialties/center-for-fracture-trauma/hip-fracture/

  Hip fractures are generally treated with surgery. Depending on the location and stability of the fracture, your doctor will develop a personalized treatment plan according to your age, physical condition and medical history. […] Very few fractured hips in adults are treated without surgery. […] Without surgery, most patients with a broken hip develop bed sores, pneumonia, recurrent urinary tract infections and experience continued pain. […] Surgeons like to fix fractured hips as soon as possible. […] The type of fracture determines the type of surgery that is required. […] Hip fractures that occur in the femoral neck may require surgery depending on the location of the break, whether the broken bones are out of place (displaced) and the severity of the fracture. […] Nondisplaced femoral neck fractures can be treated with 3 screws placed through small incisions.

• #64 Hip Fractures – Zero To Finals

  https://zerotofinals.com/surgery/orthopaedics/hipfractures/

  Non-displaced intra-capsular fractures may have an intact blood supply to the femoral head, meaning it may be possible to preserve the femoral health without avascular necrosis occurring. […] Displaced intra-capsular fractures (grade III and IV) disrupt the blood supply to the head of the femur. Therefore, the head of the femur needs to be removed and replaced. […] Extra-capsular fractures leave the blood supply to the head of the femur intact. Therefore, the head of the femur does not need to be replaced.

• #65 Hip Fracture Diagnosis, Treatments & Recovery | Reno Orthopedic Center

  https://www.renoortho.com/specialties/center-for-fracture-trauma/hip-fracture/

  Displaced femoral neck fractures are treated with full or partial hip replacements depending on patient age and function. […] It is important to choose your surgeon wisely. Extensive surgical experience can be helpful in achieving a good result and avoiding complications. […] Complications can occur with hip fracture surgery. Some of the most common risks and complications include: Infection is a risk with any surgery, no matter how small. […] Most people with hip fractures do very well and return to prior activities and function.

• #66 Hip Fractures – Zero To Finals

  https://zerotofinals.com/surgery/orthopaedics/hipfractures/

  Non-displaced intra-capsular fractures may have an intact blood supply to the femoral head, meaning it may be possible to preserve the femoral health without avascular necrosis occurring. […] Displaced intra-capsular fractures (grade III and IV) disrupt the blood supply to the head of the femur. Therefore, the head of the femur needs to be removed and replaced. […] Extra-capsular fractures leave the blood supply to the head of the femur intact. Therefore, the head of the femur does not need to be replaced.

• #67 Hip Fractures in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0201/p537.html

  The distinction between intracapsular and extracapsular fracture has prognostic value. For example, early detection of intracapsular fractures is especially important, because these fractures are prone to complications for two primary reasons. First, disruption of the blood supply to the femoral head frequently occurs and can lead to avascular necrosis. Second, the head fragment of the fracture is often a shell containing fragile cancellous bone that provides poor anchorage for a fixation device, a situation that often increases the possibility of nonunion or malunion.20,21,27 […] Most patients with hip fracture require surgical reduction and internal fixation. However, the choice of surgical procedure depends on the type of fracture, the preference of the orthopedic surgeon, the severity of the injury, the age of the patient, the presence or absence of comorbid conditions (e.g., osteoporosis, hip joint osteoarthritis), and the prognosis for recovery during rehabilitation.21 For example, extracapsular intertrochanteric fractures are typically repaired with surgical reduction and internal fixation. In contrast, treatments for intracapsular femoral neck fractures vary from internal fixation to hemiarthroplasty to total hip replacement, depending on the severity of the fracture, the stability of the joint, the patient’s condition, and the surgeon’s preference.21,27

• #68 Hip Fracture: Diagnosis, Treatment, and Secondary Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0615/p945.html

  The intertrochanteric region contains a large amount of cancellous bone and an adequate blood supply. As a result, fractures in this region typically heal well with open reduction and internal fixation, which involves surgery to reduce the displaced bone, followed by internal fixation of the fracture with plates or screws. […] Subtrochanteric fractures, however, have an increased need for intramedullary rods or nails (impact devices) and have a higher rate of impact failure, mainly because of the high stresses on this part of the femur. […] The femoral neck region has a thin periosteum, little cancellous bone, and a relatively poor blood supply. Consequently, fractures in the intracapsular region have a higher incidence of avascular necrosis, nonunion or malunion, and degenerative changes.

• #69 Hip Fracture: Diagnosis, Treatment, and Secondary Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0615/p945.html

  The timing of surgery may affect the eventual outcome. Early surgery (within 24 to 48 hours) is prudent. This allows earlier mobilization and rehabilitation, which speeds functional recovery and decreases the risk of pneumonia, skin breakdown, deep venous thrombosis, and urinary tract infections. […] Displaced fractures have an increased risk of avascular necrosis. Therefore, periodic radiography should be performed following surgery.

• #70 Hip Fracture in the ED: Background, Skeletal Anatomy, Vascular Supply

  https://emedicine.medscape.com/article/825363-overview

  Additionally, Sennerby et al identified generalized cardiovascular disease as a significant risk factor for hip fracture, […] and Carbone et al determined that heart failure increases hip fracture risk. […] Surgical delay independently affects mortality. […] Surgical delay of more than 48 hours has been shown to increase morbidity as well as mortality.

• #71 Hip Fracture: Anatomy, Causes, and Consequences | IntechOpen

  https://www.intechopen.com/chapters/64065

  The main cause of hip fracture is falling, in particular falling in sideways direction, as it induces a high level of force on the femur. […] Hip fracture is usually caused by an applied force that exceeds the strength of the femur bone. […] Osteoporosis as a progressive bone disease, which is characterized by decreases in bone mass and density, has been identified as one of the main contributors of hip fracture. […] The increasing rate of hip fracture in the elderly is mainly associated with their slower reflex response and the inability to effectively use their arms to reduce the energy of the fall and low bone density of the proximal femur. […] The aim of accurately assessing hip fracture risk is to identify patients at high risk of hip fracture and to start timely prevention and protection measures to reduce the number of hip fractures.

• #72 The pathophysiology of osteoporotic hip fracture

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2322920/

  Osteoporotic hip fractures have a profound impact on the physical health and psychosocial wellbeing of patients. […] The causes of osteoporosis and hip fracture are, however, well characterised and offer multiple opportunities both for prevention and disease management. This narrative review considers the pathophysiology of osteoporosis with particular reference to fragility fractures of the hip. […] Although osteoporosis may be caused by multiple factors, all of these are thought to act by subverting the normal physiology of healthy bone. […] A number of risk factors for reduced BMD exert their effect through subversion of the remodelling process. Indeed, osteoporosis may be seen simply as a failure of bone deposition to match the rate of resorption. […] Glucocorticoids are, however, associated with greatly reduced BMD. They are the most frequent cause of secondary osteoporosis and as many as 50% of patients receiving long-term glucocorticoid therapy sustain a fragility fracture.

• #73 Hip Fracture: Anatomy, Causes, and Consequences | IntechOpen

  https://www.intechopen.com/chapters/64065

  Fall-induced hip fracture is a major worldwide health problem among the elderly population. […] Hip fractures have several complications including medical and surgical treatment. A significant number of biomechanical models have been introduced to study hip fracture risk. The purpose of proposing the biomechanical models for predicting the hip fracture risk is to introduce prevention and protection activities that may reduce the number of hip fractures. For accurate prediction of hip fracture risk, the fracture procedure and the parameters that affect the risk of hip fracture should be well studied. […] Hip fracture is generally affected by hip anatomy, the applied forces to the hip, and bone mechanical properties. […] More than 90% of all hip fractures occur in falls as the femur is subjected to a high-level impact force.

• #74 Pathophysiology of Hip Fracture – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Group

  https://www.acibademhealthpoint.com/pathophysiology-of-hip-fracture/

  Hip fractures are a big deal, often causing issues with moving and living fully. Learning about the causes helps doctors know how to treat and support people who break a hip. […] Pathophysiology looks at how sickness or injury changes our body’s regular functions. For hip fractures, we focus on how bones, blood, and cells react, break, and heal. […] Knowing a lot about fracture pathophysiology is key. It helps check how bad a hip break is and plan the best way to heal it. Hip fractures are serious, causing less moving, pain, and sometimes even more danger for older folks. So, it’s crucial to get how these injuries affect people, to offer the best care and recovery support. […] A hip fracture happens when the bone breaks around the hip area. The body then starts to fix this break. Key steps include an early response to the break and making new bone.

• #75 Understanding the pathogenesis of hip fracture in the elderly, osteoporotic theory is not reflected in the outcome of prevention programmes

  https://www.wjgnet.com/2218-5836/full/v7/i4/218.htm

  Since hip fracture is usually caused by a fall, by identifying the population with a propensity to suffer a fall, i.e., those with a sensory or cognitive problem aggravating the risk of a fall, and then providing proper treatment for such problems, both falls and hip fractures could be prevented. […] New findings in the fields of the human genome, transcriptome and metabolomics, if appropriately addressed, would reveal the susceptibility of elderly people to falls and thus open the way to preventing many hip fractures.

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