Materiały źródłowe

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

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

  A more recent article on diagnosis and management of hip fractures is available. […] 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. Patients with hip fractures have pain in the groin and are unable to bear weight on the affected extremity. […] Plain radiography with cross-table lateral view of the hip and anteroposterior view of the pelvis usually confirms the diagnosis. If an occult hip fracture is suspected and plain radiography is normal, magnetic resonance imaging should be ordered. […] The family physician’s role involves multiple objectives: identify patients at increased risk of a hip fracture, promptly diagnose a hip fracture, facilitate long-term rehabilitation, reduce the risk of another hip fracture, and manage comorbid conditions.

• #1 Hip Fractures: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/hip-fractures.html

  Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. […] Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. […] Cross-table lateral hip and anteroposterior pelvis radiography are the initial diagnostic tests for hip fracture. […] Magnetic resonance imaging is reserved for continued suspicion of fracture despite negative plain radiography. […] Classification as intracapsular, extracapsular, displaced, or nondisplaced drives management. […] If femoral neck stress fracture is suspected, nonweight-bearing status and complete activity cessation are recommended while awaiting definitive imaging to reduce risk of conversion to complete fracture.

• #2 Understanding Hip Fractures: Diagnosis and Treatment – Sanara MedTech

  https://sanaramedtech.com/blog/understanding-hip-fractures-diagnosis-and-treatment/

  Hip fractures are common, especially in older adults, and require timely medical and surgical intervention. […] Hip fractures are a medical emergency, and delayed treatment can lead to severe consequences. […] The mortality after hip fracture in an elderly patient remains high. This ranges between 15% to 35% within the first year. […] Prompt surgical intervention, within 24 hours, reduces the risk of these complications and improves outcomes. […] Understanding the types of hip fractures and the various treatment options available is essential for guiding patients through their recovery. […] Treatment of hip fractures is influenced by the patients age, overall health, and the type of fracture. Surgery is the most common treatment for hip fractures to restore mobility, functional alignment, and reduce the risk of complications.

• #2 Hip fracture: diagnosis, treatment, and secondary prevention – PubMed

  https://pubmed.ncbi.nlm.nih.gov/25162161/

  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. Patients with hip fractures have pain in the groin and are unable to bear weight on the affected extremity. During the physical examination, displaced fractures present with external rotation and abduction, and the leg will appear shortened. Plain radiography with cross-table lateral view of the hip and anteroposterior view of the pelvis usually confirms the diagnosis. If an occult hip fracture is suspected and plain radiography is normal, magnetic resonance imaging should be ordered. […] Most fractures are treated surgically unless the patient has significant comorbidities or reduced life expectancy. The consulting orthopedic surgeon will choose the surgical procedure.

• #3 Hip fracture: diagnosis, treatment, and secondary prevention – PubMed

  https://pubmed.ncbi.nlm.nih.gov/25162161/

  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. Patients with hip fractures have pain in the groin and are unable to bear weight on the affected extremity. During the physical examination, displaced fractures present with external rotation and abduction, and the leg will appear shortened. Plain radiography with cross-table lateral view of the hip and anteroposterior view of the pelvis usually confirms the diagnosis. If an occult hip fracture is suspected and plain radiography is normal, magnetic resonance imaging should be ordered. […] Most fractures are treated surgically unless the patient has significant comorbidities or reduced life expectancy. The consulting orthopedic surgeon will choose the surgical procedure.

• #3 Diagnosing Hip & Pelvic Fractures | NYU Langone Health

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

  Orthopedic specialists at NYU Langone diagnose many types of fractures in the hip or pelvis. Using imaging tests, they can determine the location of a fracture, how many bones are affected, and whether an injury has damaged surrounding soft tissues, such as tendons, ligaments, blood vessels, or nerves. […] Our hip experts evaluate the affected hip or pelvic bone during a physical examination and confirm the diagnosis using imaging tests. […] A doctor examines your hip and pelvis to assess the extent of swelling, bruising, and tenderness. […] NYU Langone radiologists, doctors who specialize in administering and interpreting diagnostic imaging tests, work closely with orthopedic surgeons to take detailed pictures of the hip or pelvis. […] X-ray images use electromagnetic radiation to reveal the location of a fractured bone in the hip or pelvis.

• #4 Hip fracture – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000105

  Hip fractures occur predominantly in older people. The risk increases significantly with age. […] Associated most commonly with low-energy injury (e.g., fall from standing height) and osteoporosis or osteopenia. […] A hip fracture is generally considered to be any fracture of the femur distal to the femoral head and proximal to a level a few centimetres below the lesser trochanter. […] Key diagnostic factors include history of fall or trauma, pain in the affected hip, groin, or thigh, inability to bear weight or move the hip, shortened, externally rotated leg, and risk factors. […] 1st investigations to order include plain radiographs, full blood count, urea and electrolytes, glucose, group and save, coagulation screen, and ECG. […] Investigations to consider include MRI pelvis, CT pelvis, and technetium bone scan.

• #5

  https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-femur/further-reading/patient-assessment

  Consider the history of the injury. […] A femoral neck fracture is intracapsular and will have less external rotation of the leg. […] Trochanteric fractures allow greater external rotation of the leg. […] For proper radiological evaluation, x-rays in two planes at 90 to one another are necessary. […] If the trauma plain films show a potentially unstable fracture but do not give enough detail about the fracture morphology, 3-D CT imaging is a powerful tool for better diagnosis and planning for surgery. […] Plain x-rays are often sufficient to diagnose simple trochanteric fractures. […] CT imaging is the better option in this case. […] In the following cases, CT imaging is recommended: Difficulty identifying the primary fracture line, Lateral wall broken, Additional anterior cortical fragment, Intertrochanteric fracture with comminution.

• #6

  https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-femur/further-reading/patient-assessment

  Consider the history of the injury. […] A femoral neck fracture is intracapsular and will have less external rotation of the leg. […] Trochanteric fractures allow greater external rotation of the leg. […] For proper radiological evaluation, x-rays in two planes at 90 to one another are necessary. […] If the trauma plain films show a potentially unstable fracture but do not give enough detail about the fracture morphology, 3-D CT imaging is a powerful tool for better diagnosis and planning for surgery. […] Plain x-rays are often sufficient to diagnose simple trochanteric fractures. […] CT imaging is the better option in this case. […] In the following cases, CT imaging is recommended: Difficulty identifying the primary fracture line, Lateral wall broken, Additional anterior cortical fragment, Intertrochanteric fracture with comminution.

• #7 Hip Fracture: Diagnosis, Management And Treatment | Blogs

  https://www.asterhospitals.in/blogs-events-news/aster-cmi-bangalore/hip-fracture-diagnosis-management-treatment

  Hip fractures are more common in the elderly and those with osteoporosis. A hip fracture occurs when the upper section of the thigh bone breaks. […] Your doctor will inspect the region and inquire about any recent falls or mishaps. He may also touch your foot or leg and ask if you feel anything to check for nerve injury. […] Doctors usually suggest imaging investigations to identify a fracture and check for soft tissue damage. Some of them include: X-ray, which utilizes radiation to create images of your bones; Magnetic resonance imaging, which employs a powerful magnet to make images of bones and soft tissues; CT scan, a procedure that involves the use of a computer and many X-rays to provide your doctor with detailed images of the injured area. […] A hip fracture is a medical emergency. If you suspect a hip fracture, we suggest you take medical treatment at Bangalore which is renowned for orthopedic experts. For any hip emergency, book an appointment with the best orthopedic doctor in Bangalore right away.

• #8 Physical therapy in Reading, Sinking Spring, Wernersville, Berks county for Hip Pain – Fractures

  https://www.southmountainpt.com/article.php?aid=324

  The diagnosis of a hip fracture usually occurs in the emergency room. The diagnosis begins with a history and physical examination. It is important that the doctor be advised of any other medical problems the patient has so that treatment of the hip fracture can be planned. Most of the information from the history and physical examination will be used to try to evaluate the overall physical condition of the patient. Tests such as chest X-rays, blood work, and electrocardiograms may be ordered to assess the patient’s overall condition. […] X-rays are typically used to determine if a hip fracture has occurred and, if so, what type of fracture it is. The orthopedic surgeon will use the X-rays to determine if a surgical procedure will be necessary and to decide what type of procedure to suggest.

• #9 Hip fracture – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hip-fracture/diagnosis-treatment/drc-20373472

  A health care provider can often diagnose a hip fracture based on symptoms and the abnormal position of the hip and leg. An X-ray usually will confirm the fracture and show where the fracture is. […] If your X-ray doesn’t show a fracture but you still have hip pain, your provider might order an MRI or bone scan to look for a hairline fracture. […] Most hip fractures occur in one of two locations at the femoral neck or in the intertrochanteric region. The location of the fracture helps determine the best treatment options.

• #10 Hip Fractures: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36521464/

  Hip fractures are common causes of disability, with mortality rates reaching 30% at one year. […] Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. […] Two less common hip fractures can also occur: femoral neck stress fractures and insufficiency fractures.

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

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

  Plain radiography should be the initial diagnostic test in patients with suspected hip fracture. […] If radiography is negative and a hip fracture is still suspected, magnetic resonance imaging or a bone scan should be performed. […] When an older person presents with hip pain after a fall, he or she should be treated as if a hip fracture has occurred, until proven otherwise. […] Plain radiography is the initial diagnostic test for hip fracture. […] The timing of surgery may affect the eventual outcome. Early surgery (within 24 to 48 hours) is prudent. […] The consulting orthopedic surgeon determines the most appropriate surgical procedure. For femoral neck fractures, there is debate as to whether open reduction and internal fixation or arthroplasty is the better treatment.

• #12 Hip Fractures: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/hip-fractures.html

  Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. […] Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. […] Cross-table lateral hip and anteroposterior pelvis radiography are the initial diagnostic tests for hip fracture. […] Magnetic resonance imaging is reserved for continued suspicion of fracture despite negative plain radiography. […] Classification as intracapsular, extracapsular, displaced, or nondisplaced drives management. […] If femoral neck stress fracture is suspected, nonweight-bearing status and complete activity cessation are recommended while awaiting definitive imaging to reduce risk of conversion to complete fracture.

• #13 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). […] X-rays are usually diagnostic, but an MRI may be required to diagnose occult fractures or pathologic fractures. […] Obtain hip and pelvis x-rays and other hip fracture diagnostics as needed. […] Suspect occult fracture despite normal x-rays in patients with characteristic clinical features of hip fracture. […] Diagnostics for osteoporosis (e.g., to establish a pretreatment baseline) […] Preoperative cardiac assessment (e.g., echocardiogram, ECG, cardiac biomarkers) based on individual risk. […] Hip x-ray (AP with internal rotation and lateral view; should include the proximal thigh) : abnormal trabecular pattern, cortical defects, shortening and angulation of the femoral neck.

• #14

  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. […] Diagnosis is made with orthogonal radiographs of the hip. MRI is most helpful to evaluate occult hip fractures. […] Imaging: Radiographs recommended views include AP pelvis, AP hip, cross table lateral, and full length femur. […] CT indication is for second line imaging to evaluate for occult fracture. […] MRI indication is for occult hip fracture. […] Bone scan indication is for contraindication to MRI. […] Diagnostic accuracy for MRI shows sensitivity of T1-weighted 100% (most sensitive) and T2-weighted 84%. […] Diagnosis accuracy for bone scan is variable with sensitivity up to 98%.

• #15 Hip fracture – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hip-fracture/diagnosis-treatment/drc-20373472

  A health care provider can often diagnose a hip fracture based on symptoms and the abnormal position of the hip and leg. An X-ray usually will confirm the fracture and show where the fracture is. […] If your X-ray doesn’t show a fracture but you still have hip pain, your provider might order an MRI or bone scan to look for a hairline fracture. […] Most hip fractures occur in one of two locations at the femoral neck or in the intertrochanteric region. The location of the fracture helps determine the best treatment options.

• #16 Trauma X-ray – Lower limb – Hip fracture

  https://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/x-ray_trauma_lower_limb/hip_fracture_x-ray

  Not all hip fractures are visible on the initial X-ray and follow-up imaging may be required if concern remains. […] Many hip fractures are clinically and radiologically obvious. Others are more difficult to diagnose. It is important to be aware that the common clinical signs of a shortened and externally rotated leg may be absent if the fracture is not displaced. In this case the X-ray may not show an obvious fracture. Repeat X-rays, CT or MRI may be required if pain persists. […] Particular care is needed in assessing the X-ray when physical examination is limited, for example if a patient is acutely confused. […] Loss of contour of Shenton’s line is a sign of a fractured neck of femur. […] IMPORTANT NOTE: Fractures of the femoral neck do not always cause loss of Shenton’s line. […] Proximal femoral fractures either involve bone which is enveloped by the ligamentous hip joint capsule (intracapsular), or involve bone below the capsule (extracapsular).

• #17 Hip Fracture Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/hip-fracture/diagnosis.html

  Doctors use X-rays to diagnose a broken hip. […] You may need another test if your doctor thinks that you have a fracture but can’t see it on an X-ray. […] You might have a test such as: […] An MRI, which gives better images of bones and soft tissues. […] A CT scan, another way of getting more detailed images. […] A bone scan, which involves injecting a dye, then taking images. It can show hairline fractures, where the bone is cracked but the pieces are still in place.

• #18 Hip Fracture Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/87043-workup

  If the diagnosis of hip fracture is still under consideration after taking into account the patient’s history and presentation, laboratory studies should be ordered based on the patient and the potential for surgery. […] In addition to the recommended laboratory studies in a patient suspected of having a hip fracture, the physician should also obtain a chest x-ray film and an electrocardiogram (ECG) tracing to further assess the patient’s medical condition before any surgical intervention. […] X-ray films are always indicated to determine which type of fracture, if any, is present. […] If the clinical picture is highly suggestive of a fracture or stress fracture and the x-ray findings fail to demonstrate a fracture, magnetic resonance imaging (MRI), linear tomography, or bone scanning can be useful in defining otherwise imperceptible fractures.

• #19

  https://www.ortho-teaching.feinberg.northwestern.edu/cases/pelvis-hip/case7/case61diagnosis.html

  Occult Hip Fracture Diagnosis By definition, plain film radiographs are negative in occult hip fractures. According to the majority of authors, MRI is the study of choice, with 100% sensitivity and specificity reported in prospective studies evaluating its use in diagnosing occult hip fractures. […] CT is a popular choice due to accessibility. […] Radionuclide bone scanning has reported sensitivity of 93% and specificity of 95%. However, scans may not be positive until 72 hours after injury.

• #20 Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-015-0049-y

  Occult hip fractures are often difficult to identify in busy trauma units. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm. […] Definitive diagnosis of occult fractures of the proximal femur is without exception an imaging one. MRI is the imaging method of choice, better tolerated by patients providing a faster diagnosis of occult fractures of the hip, it is therefore recommended that the MRI is performed in an emergency setting whenever it is available. […] Suspicion of an occult hip fracture should arise when there is a inconsistency between the trauma history and physical examination on one hand and the imaging results on the other. […] In conclusion, any patient with a suspected hip fracture (meaning a patient with significant posttraumatic hip pain, spontaneous, on palpation, mobilization or gait) and negative X-rays should receive further imaging exploration in the first 24 h. If MRI is readily available it should be preferred as it has better accuracy in detecting occult hip fractures. If for whatever reason an MRI cannot be performed in the first 24 h, an emergency CT scan should be used instead.

• #21 Diagnosing Hip & Pelvic Fractures | NYU Langone Health

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

  Your doctor may order a CT scan to examine a fracture pattern or assess the extent of damage in the hip joint. […] If a doctor suspects a stress fracture in the hip or pelvis that cant be seen on an X-ray, or if symptoms suggest damage to ligaments, tendons, blood vessels, or nerves in addition to a fracture, your doctor may recommend an MRI. […] If you have pain and swelling that indicates a fracture but you cant have an MRI because you have a pacemaker or other implanted medical device, your doctor may recommend a bone scan.

• #22 Hip Fractures: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/hip-fractures.html

  When suspected, the first diagnostic test is plain radiography, which may show loss of cortical density, cortical thickening, or frank fracture. However, plain radiography may appear normal, and if femoral stress fracture is strongly suspected based on the patient’s symptoms and activity history, magnetic resonance imaging of the hip should be performed.

• #23 What Is A Stress Fracture Of The Hip?: Sports Medicine Oregon: Orthopedic Surgery

  https://www.sportsmedicineoregon.com/blog/what-is-a-stress-fracture-of-the-hip

  A stress fracture usually occurs when a bone is subjected to repetitive strain or impact. […] The diagnosis of a hip stress fracture will be confirmed by an X-ray, or, if the fracture is difficult to find, a bone scan or MRI. […] Pain in the hip or groin should not be ignored, especially if an individual is regularly engaged in rigorous physical activity. If the pain does not cease after rest, or pain reoccurs after putting weight or stress on the hip, it is time to consult an orthopedic physician.

• #24 Hip Fractures: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/hip-fractures.html

  Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. […] Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. […] Cross-table lateral hip and anteroposterior pelvis radiography are the initial diagnostic tests for hip fracture. […] Magnetic resonance imaging is reserved for continued suspicion of fracture despite negative plain radiography. […] Classification as intracapsular, extracapsular, displaced, or nondisplaced drives management. […] If femoral neck stress fracture is suspected, nonweight-bearing status and complete activity cessation are recommended while awaiting definitive imaging to reduce risk of conversion to complete fracture.

• #25 Diagnosing Hip & Pelvic Fractures | NYU Langone Health

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

  Your doctor may order a CT scan to examine a fracture pattern or assess the extent of damage in the hip joint. […] If a doctor suspects a stress fracture in the hip or pelvis that cant be seen on an X-ray, or if symptoms suggest damage to ligaments, tendons, blood vessels, or nerves in addition to a fracture, your doctor may recommend an MRI. […] If you have pain and swelling that indicates a fracture but you cant have an MRI because you have a pacemaker or other implanted medical device, your doctor may recommend a bone scan.

• #26 Hip fracture – Wikipedia

  https://en.wikipedia.org/wiki/Hip_fracture

  A hip fracture is usually a femoral neck fracture. […] Diagnosis is generally by X-rays. […] Magnetic resonance imaging, a CT scan, or a bone scan may occasionally be required to make the diagnosis. […] X-rays of the affected hip usually make the diagnosis obvious; AP (anteroposterior) and lateral views should be obtained. […] In situations where a hip fracture is suspected but not obvious on x-ray, an MRI is the next test of choice. If an MRI is not available or the patient can not be placed into the scanner a CT may be used as a substitute. […] As the patients most often require an operation, full pre-operative general investigation is required. This would normally include blood tests, ECG and chest x-ray.

• #27 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. […] To diagnose a hip fracture, your doctor will use a physical examination and imaging tests. […] X-rays are used to evaluate the location and severity of the broken bone. […] If multiple cracks exist, a CT(Computed Tomography) scan is often ordered to help plan treatment and surgery. […] Sometimes an MRI is ordered for small fractures or to help diagnose stress fractures that do not show up on plain x-rays. […] 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.

• #28

  https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-femur/further-reading/patient-assessment

  Consider the history of the injury. […] A femoral neck fracture is intracapsular and will have less external rotation of the leg. […] Trochanteric fractures allow greater external rotation of the leg. […] For proper radiological evaluation, x-rays in two planes at 90 to one another are necessary. […] If the trauma plain films show a potentially unstable fracture but do not give enough detail about the fracture morphology, 3-D CT imaging is a powerful tool for better diagnosis and planning for surgery. […] Plain x-rays are often sufficient to diagnose simple trochanteric fractures. […] CT imaging is the better option in this case. […] In the following cases, CT imaging is recommended: Difficulty identifying the primary fracture line, Lateral wall broken, Additional anterior cortical fragment, Intertrochanteric fracture with comminution.

• #29 Hip Fractures – Injuries; Poisoning – Merck Manual Professional Edition

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

  Hip fractures may occur in the head, neck, or area between or below the trochanters (prominences) of the femur. […] Diagnosis is by radiographs or, if needed, MRI. […] Diagnosis of a suspected hip fracture begins with an anteroposterior pelvis radiograph and a cross-table lateral view. If a fracture is identified, radiographs of the entire femur should be done. […] If a fracture is not seen on radiographs but is still suspected clinically, MRI is the preferred next imaging study. MRI is more sensitive than CT, which can miss up to 30% of acute fractures. […] If circumstances suggest a hip fracture and patients cannot flex the entire lower limb against resistance with the knee extended, suspect an impacted fracture, even if patients have only mild pain and can walk. […] If a fracture is suspected based on clinical findings but is not seen on radiographs, obtain MRI.

• #30 Hip Fracture Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/hip-fracture/diagnosis.html

  Doctors use X-rays to diagnose a broken hip. […] You may need another test if your doctor thinks that you have a fracture but can’t see it on an X-ray. […] You might have a test such as: […] An MRI, which gives better images of bones and soft tissues. […] A CT scan, another way of getting more detailed images. […] A bone scan, which involves injecting a dye, then taking images. It can show hairline fractures, where the bone is cracked but the pieces are still in place.

• #31 Hip Fracture (Broken Hip): Symptoms, Treatment, and Surgery

  https://www.webmd.com/osteoporosis/what-happens-when-you-have-a-hip-fracture

  A hip fracture is a break in the top quarter of the thighbone, which is also called the femur. […] If your doctor thinks you’ve got a broken hip, they’ll ask questions about any recent injuries or falls. They’ll do a physical exam and take X-rays. […] If the X-ray image is unclear, you may also need an MRI or bone scan. To do a bone scan, your doctor injects a very small amount of radioactive dye into a vein in your arm. The ink travels through your blood into your bones, where it can reveal fractures. […] Usually, you’ll need surgery. The type depends on the kind of fracture you have, your age, and your overall health. But first, your doctor will likely order a number of tests, like blood and urine, chest X-rays, and an electrocardiogram (EKG).

• #32 Hip Fracture Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/87043-workup

  A bone scan displays a radiographically occult fracture 80% of the time 24 hours after an injury, and it also shows almost all fractures after 72 hours. […] MRI is able to show areas of decreased signal in the marrow of the involved bone soon after the injury. […] An associated hip effusion on MRI may suggest an evolving femoral neck stress fracture.

• #33

  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. […] Diagnosis is made with orthogonal radiographs of the hip. MRI is most helpful to evaluate occult hip fractures. […] Imaging: Radiographs recommended views include AP pelvis, AP hip, cross table lateral, and full length femur. […] CT indication is for second line imaging to evaluate for occult fracture. […] MRI indication is for occult hip fracture. […] Bone scan indication is for contraindication to MRI. […] Diagnostic accuracy for MRI shows sensitivity of T1-weighted 100% (most sensitive) and T2-weighted 84%. […] Diagnosis accuracy for bone scan is variable with sensitivity up to 98%.

• #34 Hip Fracture Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/87043-workup

  If the diagnosis of hip fracture is still under consideration after taking into account the patient’s history and presentation, laboratory studies should be ordered based on the patient and the potential for surgery. […] In addition to the recommended laboratory studies in a patient suspected of having a hip fracture, the physician should also obtain a chest x-ray film and an electrocardiogram (ECG) tracing to further assess the patient’s medical condition before any surgical intervention. […] X-ray films are always indicated to determine which type of fracture, if any, is present. […] If the clinical picture is highly suggestive of a fracture or stress fracture and the x-ray findings fail to demonstrate a fracture, magnetic resonance imaging (MRI), linear tomography, or bone scanning can be useful in defining otherwise imperceptible fractures.

• #35 Hip fracture – Wikipedia

  https://en.wikipedia.org/wiki/Hip_fracture

  A hip fracture is usually a femoral neck fracture. […] Diagnosis is generally by X-rays. […] Magnetic resonance imaging, a CT scan, or a bone scan may occasionally be required to make the diagnosis. […] X-rays of the affected hip usually make the diagnosis obvious; AP (anteroposterior) and lateral views should be obtained. […] In situations where a hip fracture is suspected but not obvious on x-ray, an MRI is the next test of choice. If an MRI is not available or the patient can not be placed into the scanner a CT may be used as a substitute. […] As the patients most often require an operation, full pre-operative general investigation is required. This would normally include blood tests, ECG and chest x-ray.

• #36 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). […] X-rays are usually diagnostic, but an MRI may be required to diagnose occult fractures or pathologic fractures. […] Obtain hip and pelvis x-rays and other hip fracture diagnostics as needed. […] Suspect occult fracture despite normal x-rays in patients with characteristic clinical features of hip fracture. […] Diagnostics for osteoporosis (e.g., to establish a pretreatment baseline) […] Preoperative cardiac assessment (e.g., echocardiogram, ECG, cardiac biomarkers) based on individual risk. […] Hip x-ray (AP with internal rotation and lateral view; should include the proximal thigh) : abnormal trabecular pattern, cortical defects, shortening and angulation of the femoral neck.

• #37 Clinical diagnosis: Fragility hip fracture | Oncohema Key

  https://oncohemakey.com/clinical-diagnosis-fragility-hip-fracture/

  A DXA scan, however, is needed to establish the patient’s baseline bone mineral density and evaluate her response (or lack thereof) to any prescribed medication. […] Fragility fractures are diagnostic of osteoporosis even in the absence of densitometric evidence of osteoporosis, provided other metabolic bone diseases have been excluded. […] The menopause is a major factor predisposing to a reduced bone mass, increased bone fragility, and osteoporosis. […] Osteoporosis is essentially asymptomatic until a fragility fracture occurs. […] The National Bone Health Alliance Working Group recommends postmenopausal women and men aged 50 years and older be treated for osteoporosis if their 10-year fracture risk is or exceeds 3% for the hip or 20% (major) fracture. […] Diagnosis: Osteoporosis, status postfragility hip fracture.

• #38 ICD-10 Codes for Hip Fractures

  https://www.outsourcestrategies.com/blog/icd-10-coding-for-hip-fractures/

  Fractures of the proximal femur, commonly referred to as hip fractures, are common among elderly patients with osteoporosis. […] In such cases, additional imaging studies, including repeat X-rays, CT scans, or MRIs, may be necessary to confirm the diagnosis. […] Accurately reporting hip fractures using ICD-10 codes presents its own challenges, as the coding process demands a high level of specificity and detailed documentation. […] Accurate ICD-10 coding depends on detailed clinical documentation to capture specifics about fracture type, location, laterality (right, left, or unspecified), and adding extensions to indicate the encounter and healing process. […] While traumatic fractures are typically identified based on injury history and imaging, pathological fractures often require additional tests (e.g., bone scans, biopsies, or lab work) to identify the underlying condition.

• #39 Hip Fractures – OrthoPaedia

  https://www.orthopaedia.com/hip-fractures/

  If an occult hip fracture is suspected, an MRI of the hip should be obtained. […] While there is no laboratory test that can detect a hip fracture, once a hip fracture is diagnosed, pre-operative blood tests and all other pre-operative tests (e.g. EKG and CXR) should be performed expeditiously. […] Blood tests to assess for malnutrition and treatable causes of metabolic bone disease should be obtained in all elderly patients and in young patients with stress fractures. […] In the setting of high-energy trauma, a patient presenting with groin pain could have a pelvic fracture or a hip dislocation. […] The differential diagnosis of gradual, atraumatic hip pain includes labral tears, osteoarthritis, inflammatory arthritis, avascular necrosis, septic arthritis, trochanteric bursitis, tendinopathy, primary or metastatic bone tumors, hernia, genitourinary causes, vascular claudication, or lumbar radiculopathy.

• #40 Diagnosis and Tests for Fractures | American Geriatrics Society | HealthInAging.org

  https://www.healthinaging.org/a-z-topic/fractures/tests

  X-rays usually confirm whether a person has a broken bone and where any loose bony pieces may be. […] One of the first tests a healthcare professional will order is a bone mineral density (BMD) test. […] The FRAX tool has been developed to predict the risk of a fracture. […] Your healthcare professional may order blood tests such as: […] If the x-ray does not show a fracture but your healthcare provider still thinks you might have one, other imaging tests may be necessary such as:

• #41 Clinical diagnosis: Fragility hip fracture | Oncohema Key

  https://oncohemakey.com/clinical-diagnosis-fragility-hip-fracture/

  Osteoporosis is a silent, asymptomatic disease until a fracture is sustained. […] Fragility fractures are diagnostic of osteoporosis, regardless of densitometric findings, but after excluding localized bone diseases. […] Once a fragility fracture has occurred the risk of subsequent fragility fractures is substantially increased, hence the importance of including the term: fragility fracture with the diagnosis. […] Fragility fractures occur most commonly in the vertebrae and are also diagnostic of osteoporosis after excluding secondary causes of localized osteoporosis. […] The final diagnosis of MT’s bone status is therefore osteoporosis, status postfragility right hip fracture or established osteoporosis. There is no need for further diagnostic tests, including a DXA scan, to confirm the diagnosis of osteoporosis.

• #42 Hip Fractures: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/hip-fractures.html

  Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. […] Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. […] Cross-table lateral hip and anteroposterior pelvis radiography are the initial diagnostic tests for hip fracture. […] Magnetic resonance imaging is reserved for continued suspicion of fracture despite negative plain radiography. […] Classification as intracapsular, extracapsular, displaced, or nondisplaced drives management. […] If femoral neck stress fracture is suspected, nonweight-bearing status and complete activity cessation are recommended while awaiting definitive imaging to reduce risk of conversion to complete fracture.

• #43 Hip Fracture | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/h/hip-fracture.html

  A hip fracture is a break in the thighbone (femur) of your hip joint. […] Hip fracture is a serious injury and needs immediate medical attention. […] A hip fracture is classified by the specific area of the break and the type of break or breaks in your bone. […] The most common types of hip fractures are: […] A femoral neck fracture happens 1 to 2 inches from your hip joint. […] An intertrochanteric hip fracture happens 3 to 4 inches from your hip joint. […] Another type of fracture, called a stress fracture of the hip, may be harder to diagnose. […] The symptoms of hip fracture may seem like other medical conditions. Always see your healthcare provider for a diagnosis. […] In addition to a complete medical history and physical exam, diagnostic procedures for hip fracture may include the following:

• #44 Trauma X-ray – Lower limb – Hip fracture

  https://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/x-ray_trauma_lower_limb/hip_fracture_x-ray

  Intracapsular fractures include subcapital (below the femoral head), transcervical (across the mid-femoral neck), or basicervical (across the base of the femoral neck). These injuries may be correctly termed fractures of the 'neck of femur’ (NOF). […] The Garden classification system is a traditional means of assessing severity of neck of femur fractures. The system broadly corresponds with prognosis – the more displaced, the more likely the blood supply to the femoral head is compromised. In reality the distinction between the classes can be difficult. […] Loss of Shenton’s line. […] Complete fracture of the full diameter of the femoral neck. […] Total displacement of the 2 fracture components. […] Extracapsular fractures of the proximal femur include intertrochanteric (between the trochanters) and subtrochanteric (distal to the trochanters). These fractures do not involve the neck of the femur.

• #45 Hip Fractures – OrthoPaedia

  https://www.orthopaedia.com/hip-fractures/

  Although the hip joint comprises the acetabulum, the femoral head and neck, the greater and lesser trochanters, and the proximal femoral shaft, the term “hip fracture” is typically limited to a fracture of the femoral neck or of the inter-trochanteric region, that is, the region between the greater and lesser trochanters. […] Hip fractures may be seen in younger patients with high energy mechanisms of injury (a motor vehicle collision, for instance), but most cases are seen in older patients after a low energy mechanism of injury such as a fall from a standing height. […] About one third of elderly patients with a low energy hip fracture are apt to die within a year of the injury. […] Intracapsular femoral neck fractures can be further classified by their specific location in the neck: subcapital (under the head), transcervical (across the neck), and basi-cervical (base of neck).

• #46 Hip Fractures – OrthoPaedia

  https://www.orthopaedia.com/hip-fractures/

  Extracapsular fractures occur in the area between and within the greater and lesser trochanters and are called “intertrochanteric” fractures. […] The blood supply to the hip varies by region, and thus the region in which a fracture occurs strongly influences the fracture’s healing potential and appropriate treatment. […] Healing of femoral neck fractures can be compromised by the lack of blood supply. […] Both young and old people with a hip fracture usually present with groin pain and, in the case of displacement, a shortened and externally-rotated leg. […] Initial imaging for suspected hip fractures should include x-rays of an AP pelvis and AP and lateral views of the affected hip. […] Minimally-displaced or non-displaced hip fractures may present with subtle disruption of the trabecular lines.

• #47 Trauma X-ray – Lower limb – Hip fracture

  https://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/x-ray_trauma_lower_limb/hip_fracture_x-ray

  Intracapsular fractures include subcapital (below the femoral head), transcervical (across the mid-femoral neck), or basicervical (across the base of the femoral neck). These injuries may be correctly termed fractures of the 'neck of femur’ (NOF). […] The Garden classification system is a traditional means of assessing severity of neck of femur fractures. The system broadly corresponds with prognosis – the more displaced, the more likely the blood supply to the femoral head is compromised. In reality the distinction between the classes can be difficult. […] Loss of Shenton’s line. […] Complete fracture of the full diameter of the femoral neck. […] Total displacement of the 2 fracture components. […] Extracapsular fractures of the proximal femur include intertrochanteric (between the trochanters) and subtrochanteric (distal to the trochanters). These fractures do not involve the neck of the femur.

• #48 Trauma X-ray – Lower limb – Hip fracture

  https://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/x-ray_trauma_lower_limb/hip_fracture_x-ray

  Intracapsular fractures include subcapital (below the femoral head), transcervical (across the mid-femoral neck), or basicervical (across the base of the femoral neck). These injuries may be correctly termed fractures of the 'neck of femur’ (NOF). […] The Garden classification system is a traditional means of assessing severity of neck of femur fractures. The system broadly corresponds with prognosis – the more displaced, the more likely the blood supply to the femoral head is compromised. In reality the distinction between the classes can be difficult. […] Loss of Shenton’s line. […] Complete fracture of the full diameter of the femoral neck. […] Total displacement of the 2 fracture components. […] Extracapsular fractures of the proximal femur include intertrochanteric (between the trochanters) and subtrochanteric (distal to the trochanters). These fractures do not involve the neck of the femur.

• #49 Hip Fractures: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/hip-fractures.html

  Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. […] Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. […] Cross-table lateral hip and anteroposterior pelvis radiography are the initial diagnostic tests for hip fracture. […] Magnetic resonance imaging is reserved for continued suspicion of fracture despite negative plain radiography. […] Classification as intracapsular, extracapsular, displaced, or nondisplaced drives management. […] If femoral neck stress fracture is suspected, nonweight-bearing status and complete activity cessation are recommended while awaiting definitive imaging to reduce risk of conversion to complete fracture.

• #50 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. […] To diagnose a hip fracture, your doctor will use a physical examination and imaging tests. […] X-rays are used to evaluate the location and severity of the broken bone. […] If multiple cracks exist, a CT(Computed Tomography) scan is often ordered to help plan treatment and surgery. […] Sometimes an MRI is ordered for small fractures or to help diagnose stress fractures that do not show up on plain x-rays. […] 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.

• #51 Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-015-0049-y

  Occult hip fractures are often difficult to identify in busy trauma units. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm. […] Definitive diagnosis of occult fractures of the proximal femur is without exception an imaging one. MRI is the imaging method of choice, better tolerated by patients providing a faster diagnosis of occult fractures of the hip, it is therefore recommended that the MRI is performed in an emergency setting whenever it is available. […] Suspicion of an occult hip fracture should arise when there is a inconsistency between the trauma history and physical examination on one hand and the imaging results on the other. […] In conclusion, any patient with a suspected hip fracture (meaning a patient with significant posttraumatic hip pain, spontaneous, on palpation, mobilization or gait) and negative X-rays should receive further imaging exploration in the first 24 h. If MRI is readily available it should be preferred as it has better accuracy in detecting occult hip fractures. If for whatever reason an MRI cannot be performed in the first 24 h, an emergency CT scan should be used instead.

• #52 The Consequence of Delayed Diagnosis of an Occult Hip Fracture

  https://www.jtraumainj.org/journal/view.php?doi=10.20408/jti.2015.28.3.91

  PURPOSE Occult hip fracture is not evident on radiographs and the diagnosis is often missed or delayed. This study was undertaken in order to identify the clinical characteristics and complications of patients with a delayed diagnosis of an occult hip fracture. […] A delayed diagnosis of occult hip fractures was associated with increased rate of displacement and operation. In patients suspected of having occult hip fractures, additional studies should be recommended.

• #53 Physical therapy in Reading, Sinking Spring, Wernersville, Berks county for Hip Pain – Fractures

  https://www.southmountainpt.com/article.php?aid=324

  In a few cases, X-rays may not show the fracture. If the hip continues to hurt and the doctor is suspicious that a hip fracture is present, magnetic resonance imaging (MRI) may be suggested. The MRI scanner uses magnetic waves rather than radiation to take multiple pictures of the hip bones. The MRI machine is very sensitive and can show fractures that do not show up on regular X-rays. […] This test is done to be certain there is no fracture before allowing the patient to put weight on the leg. Walking on a fractured hip may cause the two sides of the fracture to displace, or move apart, so that they no longer line up correctly. A fracture that has not displaced is much easier to treat than one that has. A displaced fracture also increases the risk of damaging the blood supply to the femoral head, causing AVN (discussed earlier).

• #54 Deep learning predicts hip fracture using confounding patient and healthcare variables | npj Digital Medicine

  https://www.nature.com/articles/s41746-019-0105-1

  Hip fractures are a leading cause of death and disability among older adults. Hip fractures are also the most commonly missed diagnosis on pelvic radiographs, and delayed diagnosis leads to higher cost and worse outcomes. Computer-aided diagnosis (CAD) algorithms have shown promise for helping radiologists detect fractures, but the image features underpinning their predictions are notoriously difficult to understand. […] Fracture was predicted moderately well from the image (AUC=0.78) and better when combining image features with patient data (AUC=0.86, DeLong paired AUC comparison, p=2e-9) or patient data plus hospital process features (AUC=0.91, p=1e-21). […] Fractures are the most commonly missed diagnosis on radiographs of the spine and extremities, and the majority of these errors are perceptual (i.e., a radiologist not noticing some abnormality as opposed to misinterpreting a recognized anomaly).

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

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

  Plain radiography should be the initial diagnostic test in patients with suspected hip fracture. […] If radiography is negative and a hip fracture is still suspected, magnetic resonance imaging or a bone scan should be performed. […] When an older person presents with hip pain after a fall, he or she should be treated as if a hip fracture has occurred, until proven otherwise. […] Plain radiography is the initial diagnostic test for hip fracture. […] The timing of surgery may affect the eventual outcome. Early surgery (within 24 to 48 hours) is prudent. […] The consulting orthopedic surgeon determines the most appropriate surgical procedure. For femoral neck fractures, there is debate as to whether open reduction and internal fixation or arthroplasty is the better treatment.

• #56 Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-015-0049-y

  Occult hip fractures are often difficult to identify in busy trauma units. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm. […] Definitive diagnosis of occult fractures of the proximal femur is without exception an imaging one. MRI is the imaging method of choice, better tolerated by patients providing a faster diagnosis of occult fractures of the hip, it is therefore recommended that the MRI is performed in an emergency setting whenever it is available. […] Suspicion of an occult hip fracture should arise when there is a inconsistency between the trauma history and physical examination on one hand and the imaging results on the other. […] In conclusion, any patient with a suspected hip fracture (meaning a patient with significant posttraumatic hip pain, spontaneous, on palpation, mobilization or gait) and negative X-rays should receive further imaging exploration in the first 24 h. If MRI is readily available it should be preferred as it has better accuracy in detecting occult hip fractures. If for whatever reason an MRI cannot be performed in the first 24 h, an emergency CT scan should be used instead.

• #57 Hip Fractures – Injuries; Poisoning – Merck Manual Professional Edition

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

  Hip fractures may occur in the head, neck, or area between or below the trochanters (prominences) of the femur. […] Diagnosis is by radiographs or, if needed, MRI. […] Diagnosis of a suspected hip fracture begins with an anteroposterior pelvis radiograph and a cross-table lateral view. If a fracture is identified, radiographs of the entire femur should be done. […] If a fracture is not seen on radiographs but is still suspected clinically, MRI is the preferred next imaging study. MRI is more sensitive than CT, which can miss up to 30% of acute fractures. […] If circumstances suggest a hip fracture and patients cannot flex the entire lower limb against resistance with the knee extended, suspect an impacted fracture, even if patients have only mild pain and can walk. […] If a fracture is suspected based on clinical findings but is not seen on radiographs, obtain MRI.

• #58 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/9bc98f12b43c9174123d82eeb6e9c857

  If the hip continues to hurt and the doctor is suspicious that a hip fracture is present, magnetic resonance imaging (MRI) may be suggested. The MRI scanner uses magnetic waves rather than radiation to take multiple pictures of the hip bones. The MRI machine is very sensitive and can show fractures that do not show up on regular X-rays. […] The treatment for a hip fracture begins immediately by making sure the patient is medically stable. Once the doctor is sure that the patient is stable, decisions concerning the treatment of the fracture can be made. […] Nearly all hip fractures in the elderly are treated with some type of surgical operation to fix the fractured bones. If possible, the surgery is normally done within 24 hours of admission to the hospital. […] The goal of any surgical procedure to treat a fractured hip is to hold the broken bones securely in position, allowing the patient to get out of bed as soon as possible.

• #59 Deep learning predicts hip fracture using confounding patient and healthcare variables | npj Digital Medicine

  https://www.nature.com/articles/s41746-019-0105-1

  Statistical learning models can both detect fractures and help radiologists detect fractures. […] Most studies detect fracture in algorithm-only systems. […] Gale et al. developed the only previously reported hip fracture detector using DL; their model achieved an area under the receiver-operating curve (AUC) of 0.994. […] We perform a comprehensive analysis of what patient and hospital process variables DL can detect in radiographs and whether they contribute to the inner workings of a fracture detection model. […] We transformed all scalar variables into binary factors and trained logistic regression models for fracture, PTs, and HPs as described in detail in the Methods section. […] Hip fracture was detected with AUC 0.78 (95% CI: 0.740.81), and the best detected secondary targets were the device that took the scan (AUC 1, CI 11), scanner manufacturer (AUC 0.98, 95% CI 0.980.99), and whether the image was ordered as a high priority (AUC 0.79, 95% CI 0.770.80).

• #60

  https://link.springer.com/article/10.1007/s40134-018-0281-9

  To summarize relevant anatomy, imaging, and treatment of hip fractures, and to synthesize a treatment-based approach for description and classification of hip fractures. […] Radiographs are the principal imaging modality for assessment of hip fracture, although there is a clear role for CT and MRI for assessment of radiographically occult fractures. […] A simplified anatomic and treatment-based approach to hip fractures can help guide image interpretation and clinical management. […] The role of MRI in the diagnosis of occult hip fractures. […] The use of computed tomography in identifying radiologically occult hip fractures in the elderly. […] The validity of investigating occult hip fractures using multidetector CT. […] The sensitivity of CT scans in diagnosing occult femoral neck fractures.

• #61 Fracture Hip X-Ray Guide: Diagnosis & Insight – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Group

  https://www.acibademhealthpoint.com/fracture-hip-x-ray-guide-diagnosis-insight/

  First, the patient must get ready for the x-ray. They should take off clothes and jewelry. They will wear a hospital gown instead. […] Putting the hip in the right spot for the x-ray is crucial. Two main views are used, the anteroposterior (AP) and lateral views. […] Looking at a hip fracture X-ray is key to spotting different types of breaks. You need a sharp eye and radiology smarts to see the signs. […] Radiologists look for signs that show what kind of fracture it is. For example, intracapsular fractures are close to the femoral head. […] Advanced hip fracture imaging has changed how we diagnose. Traditional X-rays are important first. But, MRI and CT scans give very detailed and accurate information. […] When doctors look at hip fractures, they choose between an X-ray, MRI, or CT scan. This choice is very important for finding the problem accurately and quickly.

• #62

  https://link.springer.com/article/10.1007/s40134-018-0281-9

  To summarize relevant anatomy, imaging, and treatment of hip fractures, and to synthesize a treatment-based approach for description and classification of hip fractures. […] Radiographs are the principal imaging modality for assessment of hip fracture, although there is a clear role for CT and MRI for assessment of radiographically occult fractures. […] A simplified anatomic and treatment-based approach to hip fractures can help guide image interpretation and clinical management. […] The role of MRI in the diagnosis of occult hip fractures. […] The use of computed tomography in identifying radiologically occult hip fractures in the elderly. […] The validity of investigating occult hip fractures using multidetector CT. […] The sensitivity of CT scans in diagnosing occult femoral neck fractures.

• #63

  https://link.springer.com/article/10.1007/s40134-018-0281-9

  Magnetic resonance imaging identifies occult hip fractures missed by 64-slice computed tomography. […] Sensitivity and specificity of CT- and MRI-scanning in evaluation of occult fracture of the proximal femur. […] Comparison of MRI with bone scanning for suspected hip fracture in elderly patients. […] Diagnosis of occult fractures about the hip. Magnetic resonance imaging compared with bone-scanning.

• #64

  https://link.springer.com/article/10.1007/s40134-018-0281-9

  Magnetic resonance imaging identifies occult hip fractures missed by 64-slice computed tomography. […] Sensitivity and specificity of CT- and MRI-scanning in evaluation of occult fracture of the proximal femur. […] Comparison of MRI with bone scanning for suspected hip fracture in elderly patients. […] Diagnosis of occult fractures about the hip. Magnetic resonance imaging compared with bone-scanning.

• #65

  https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-femur/further-reading/patient-assessment

  An undisplaced fracture may also be referred to as occult fracture as it is not well visible in an x-ray and may not be diagnosed correctly. […] If clinical assessment indicates a neck fracture, but the x-ray does not show clear signs of it, CT or MRI imaging is recommended. […] Displaced femoral neck fractures show disruption of the medial and lateral cortical line in the AP x-ray. […] 3-D CT imaging is highly recommended to understand the morphology of the fracture and comminution. […] CT is standard imaging as it provides the most accurate information of the fracture. […] In combined fractures of the greater trochanter, the femoral head and neck, and/or the posterior wall of the acetabulum, CT imaging is necessary for recognizing the fracture pattern, decision making, and preoperative planning.

• #66 Deep learning predicts hip fracture using confounding patient and healthcare variables | npj Digital Medicine

  https://www.nature.com/articles/s41746-019-0105-1

  Statistical learning models can both detect fractures and help radiologists detect fractures. […] Most studies detect fracture in algorithm-only systems. […] Gale et al. developed the only previously reported hip fracture detector using DL; their model achieved an area under the receiver-operating curve (AUC) of 0.994. […] We perform a comprehensive analysis of what patient and hospital process variables DL can detect in radiographs and whether they contribute to the inner workings of a fracture detection model. […] We transformed all scalar variables into binary factors and trained logistic regression models for fracture, PTs, and HPs as described in detail in the Methods section. […] Hip fracture was detected with AUC 0.78 (95% CI: 0.740.81), and the best detected secondary targets were the device that took the scan (AUC 1, CI 11), scanner manufacturer (AUC 0.98, 95% CI 0.980.99), and whether the image was ordered as a high priority (AUC 0.79, 95% CI 0.770.80).

• #67

  https://www.jseamed.org/index.php/jseamed/article/view/111

  Most hip fractures occur among elderly people. They are usually treated in the emergency room where orthopedic surgeons may not be readily available. The problem of delayed diagnosis and treatment results increase risks of further complications and mortality rate. Thus, applying artificial intelligence (AI) can assist physicians having limited experience to rapidly and confidently diagnose hip fractures using radiographs. […] This study aimed to validate AI programs to assist diagnosing of hip fractures on plain radiographs. […] The performance of the AI program was compared with one orthopedic surgeon who reviewed the same images. The accuracy, sensitivity and specificity of the diagnosis of hip fractures between the orthopedic surgeon and AI program were analyzed. […] The orthopedic surgeon and AI program revealed an accuracy of 93.59% (95%CI 90.8-95.73) vs. 81.24% (95% CI 77.17-84.85), sensitivity of 90.30% (95% CI 85.60-93.90) vs. 89.40% (95%CI 84.50-93.20) and specificity of 97.10% (95%CI 93.60-98.90) vs. 72.5% (95%CI 65.90-78.50), respectively.

• #68 Deep learning predicts hip fracture using confounding patient and healthcare variables | npj Digital Medicine

  https://www.nature.com/articles/s41746-019-0105-1

  We sought to disentangle the ability of a CNN to directly detect fracture versus indirectly predicting fracture by detecting confounding variables associated with fracture. […] When deep learning rare conditions, it is common to perform class balancing by downsampling normal examples, but this is generally done randomly without considering PT or HP variables. […] This loss of predictive performance indicates that the model was predicting fracture indirectly through these associated variables rather than directly measuring the image features of fracture. […] Although our model was dependent on covariates to predict fracture, the previously reported DL model for hip fracture detection by Gale et al. was not. […] DL algorithms can predict hip fracture from hip radiographs, as well as many patient and hospital process variables that are associated with fracture.

• #69 Fracture Hip X-Ray Guide: Diagnosis & Insight – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Group

  https://www.acibademhealthpoint.com/fracture-hip-x-ray-guide-diagnosis-insight/

  Wrongly diagnosing a hip fracture on an X-ray can be very bad for patients. Finding mistakes in the pictures is key to fixing this. […] Radiologists are key in spotting hip fractures on X-rays. Their job is to look at the images closely. They figure out what kind of fracture it is. […] Understanding X-Ray findings for a fracture hip is key for proper diagnosis and treatment. When looking at an x-ray, focus on the femoral head’s alignment with the acetabulum. […] Hip fracture diagnosis is changing a lot because of new imaging tech. One big change is using AI in radiology.

• #70

  https://www.jseamed.org/index.php/jseamed/article/view/111

  Most hip fractures occur among elderly people. They are usually treated in the emergency room where orthopedic surgeons may not be readily available. The problem of delayed diagnosis and treatment results increase risks of further complications and mortality rate. Thus, applying artificial intelligence (AI) can assist physicians having limited experience to rapidly and confidently diagnose hip fractures using radiographs. […] This study aimed to validate AI programs to assist diagnosing of hip fractures on plain radiographs. […] The performance of the AI program was compared with one orthopedic surgeon who reviewed the same images. The accuracy, sensitivity and specificity of the diagnosis of hip fractures between the orthopedic surgeon and AI program were analyzed. […] The orthopedic surgeon and AI program revealed an accuracy of 93.59% (95%CI 90.8-95.73) vs. 81.24% (95% CI 77.17-84.85), sensitivity of 90.30% (95% CI 85.60-93.90) vs. 89.40% (95%CI 84.50-93.20) and specificity of 97.10% (95%CI 93.60-98.90) vs. 72.5% (95%CI 65.90-78.50), respectively.

• #71

  https://www.jseamed.org/index.php/jseamed/article/view/111

  Our results showed that the AI model (VGG16) showed a sensitivity of 89.40% vs. 90.30% obtained from the orthopedic surgeon. Thus, improvement in the sensitivity and specificity of AI software is further required. In the future, AI models have the potential as useful tools for emergent screening and evaluation of patients with hip fractures using plain radiographs, especially in the Emergency Department where orthopedic surgeons may not be readily available.

• #72 Deep learning predicts hip fracture using confounding patient and healthcare variables | npj Digital Medicine

  https://www.nature.com/articles/s41746-019-0105-1

  We sought to disentangle the ability of a CNN to directly detect fracture versus indirectly predicting fracture by detecting confounding variables associated with fracture. […] When deep learning rare conditions, it is common to perform class balancing by downsampling normal examples, but this is generally done randomly without considering PT or HP variables. […] This loss of predictive performance indicates that the model was predicting fracture indirectly through these associated variables rather than directly measuring the image features of fracture. […] Although our model was dependent on covariates to predict fracture, the previously reported DL model for hip fracture detection by Gale et al. was not. […] DL algorithms can predict hip fracture from hip radiographs, as well as many patient and hospital process variables that are associated with fracture.

• #73 Hip fracture or not? The reversed prevalence effect among non-experts’ diagnosis | Cognitive Research: Principles and Implications | Full Text

  https://cognitiveresearchjournal.springeropen.com/articles/10.1186/s41235-022-00455-w

  Therefore, factors such as learning, memory, and expectations that shape experts top-down medical image perception also influence the prevalence reports. […] In this study, we introduced radiographs of hip fracture as a model to investigate the possible interaction between prevalence and expertise to mitigate the issues discussed above. […] Considering that up to one-third of the older adult patients with hip fractures would exhibit permanent functional loss and severe dependence at 1-year follow-up, it is essential to explore the influence of prevalence effect on hip fracture diagnosis as a function of medical practitioners experience to prevent the fracture from being initially missed. […] Our results indicate that the bias in answering fracture-present depends very much on the prevalence context that medical practitioners are presented with. Specifically, experts held more conservative criteria in the low-prevalence condition, whereas novices showed the opposite pattern and were more likely to believe there is a fracture in the same low-prevalence condition. […] We believe this line of research can contribute to medical education and training, as well as other applied clinical diagnoses to mitigate the prevalence effect.

• #74 Hip fracture or not? The reversed prevalence effect among non-experts’ diagnosis | Cognitive Research: Principles and Implications | Full Text

  https://cognitiveresearchjournal.springeropen.com/articles/10.1186/s41235-022-00455-w

  Despite numerous investigations of the prevalence effect on medical image perception, little research has been done to examine the effect of expertise, and its possible interaction with prevalence. […] In this study, medical practitioners were instructed to detect the presence of hip fracture in 50 X-ray images with either high prevalence or low prevalence. […] Importantly, participants detection discriminability did not vary by the prevalence condition. […] Our work can contribute to medical education training as well as other applied clinical diagnosis that aims to mitigate the prevalence effect. […] Medical practitioners, both experts and novices, in hip fracture were shown X-ray images and asked to indicate whether hip fracture is present or not in every image. […] Our data indicate an opposite effect in criterion shift between experts and novices: Where experts became more conservative when there were fewer targets, novices were more likely report fracture-present in the same target-rare condition.

• #75 Hip fracture or not? The reversed prevalence effect among non-experts’ diagnosis | Cognitive Research: Principles and Implications | Full Text

  https://cognitiveresearchjournal.springeropen.com/articles/10.1186/s41235-022-00455-w

  Therefore, factors such as learning, memory, and expectations that shape experts top-down medical image perception also influence the prevalence reports. […] In this study, we introduced radiographs of hip fracture as a model to investigate the possible interaction between prevalence and expertise to mitigate the issues discussed above. […] Considering that up to one-third of the older adult patients with hip fractures would exhibit permanent functional loss and severe dependence at 1-year follow-up, it is essential to explore the influence of prevalence effect on hip fracture diagnosis as a function of medical practitioners experience to prevent the fracture from being initially missed. […] Our results indicate that the bias in answering fracture-present depends very much on the prevalence context that medical practitioners are presented with. Specifically, experts held more conservative criteria in the low-prevalence condition, whereas novices showed the opposite pattern and were more likely to believe there is a fracture in the same low-prevalence condition. […] We believe this line of research can contribute to medical education and training, as well as other applied clinical diagnoses to mitigate the prevalence effect.

• #76 Hip fracture or not? The reversed prevalence effect among non-experts’ diagnosis | Cognitive Research: Principles and Implications | Full Text

  https://cognitiveresearchjournal.springeropen.com/articles/10.1186/s41235-022-00455-w

  Therefore, factors such as learning, memory, and expectations that shape experts top-down medical image perception also influence the prevalence reports. […] In this study, we introduced radiographs of hip fracture as a model to investigate the possible interaction between prevalence and expertise to mitigate the issues discussed above. […] Considering that up to one-third of the older adult patients with hip fractures would exhibit permanent functional loss and severe dependence at 1-year follow-up, it is essential to explore the influence of prevalence effect on hip fracture diagnosis as a function of medical practitioners experience to prevent the fracture from being initially missed. […] Our results indicate that the bias in answering fracture-present depends very much on the prevalence context that medical practitioners are presented with. Specifically, experts held more conservative criteria in the low-prevalence condition, whereas novices showed the opposite pattern and were more likely to believe there is a fracture in the same low-prevalence condition. […] We believe this line of research can contribute to medical education and training, as well as other applied clinical diagnoses to mitigate the prevalence effect.

• #77 Hip Fractures – OrthoPaedia

  https://www.orthopaedia.com/hip-fractures/

  If an occult hip fracture is suspected, an MRI of the hip should be obtained. […] While there is no laboratory test that can detect a hip fracture, once a hip fracture is diagnosed, pre-operative blood tests and all other pre-operative tests (e.g. EKG and CXR) should be performed expeditiously. […] Blood tests to assess for malnutrition and treatable causes of metabolic bone disease should be obtained in all elderly patients and in young patients with stress fractures. […] In the setting of high-energy trauma, a patient presenting with groin pain could have a pelvic fracture or a hip dislocation. […] The differential diagnosis of gradual, atraumatic hip pain includes labral tears, osteoarthritis, inflammatory arthritis, avascular necrosis, septic arthritis, trochanteric bursitis, tendinopathy, primary or metastatic bone tumors, hernia, genitourinary causes, vascular claudication, or lumbar radiculopathy.

• #78 Clinical diagnosis: Fragility hip fracture | Oncohema Key

  https://oncohemakey.com/clinical-diagnosis-fragility-hip-fracture/

  Osteoporosis is a silent, asymptomatic disease until a fracture is sustained. […] Fragility fractures are diagnostic of osteoporosis, regardless of densitometric findings, but after excluding localized bone diseases. […] Once a fragility fracture has occurred the risk of subsequent fragility fractures is substantially increased, hence the importance of including the term: fragility fracture with the diagnosis. […] Fragility fractures occur most commonly in the vertebrae and are also diagnostic of osteoporosis after excluding secondary causes of localized osteoporosis. […] The final diagnosis of MT’s bone status is therefore osteoporosis, status postfragility right hip fracture or established osteoporosis. There is no need for further diagnostic tests, including a DXA scan, to confirm the diagnosis of osteoporosis.

• #79 Diagnosis and Management of Sarcopenia after Hip Fracture Surgery: Current Concept Review

  https://www.hipandpelvis.or.kr/journal/view.html?doi=10.5371/hp.2022.34.1.1

  To date, family medicine and internal medicine fields have been responsible for defining, researching, and development of treatments for sarcopenia, focusing mainly on diabetes and metabolic diseases. […] Therefore, application of current guidelines for diagnosis of sarcopenia which differ according to continent to patients with hip fractures in the orthopedic field is difficult. […] The global prevalence of sarcopenia in patients with hip fractures is statistically significant. Despite establishment of various therapeutic and diagnostic criteria for osteoporosis in the clinical field, there are no clear, useful diagnostic criteria for sarcopenia in the clinical field. […] For patients with hip fractures, diagnosis of sarcopenia is based on diagnostic criteria for acute to chronic health care settings. However, evaluation of physical ability in patients with hip fractures is not possible. Only grip strength can be measured.

• #80 Diagnosis and Management of Sarcopenia after Hip Fracture Surgery: Current Concept Review

  https://www.hipandpelvis.or.kr/journal/view.html?doi=10.5371/hp.2022.34.1.1

  To date, family medicine and internal medicine fields have been responsible for defining, researching, and development of treatments for sarcopenia, focusing mainly on diabetes and metabolic diseases. […] Therefore, application of current guidelines for diagnosis of sarcopenia which differ according to continent to patients with hip fractures in the orthopedic field is difficult. […] The global prevalence of sarcopenia in patients with hip fractures is statistically significant. Despite establishment of various therapeutic and diagnostic criteria for osteoporosis in the clinical field, there are no clear, useful diagnostic criteria for sarcopenia in the clinical field. […] For patients with hip fractures, diagnosis of sarcopenia is based on diagnostic criteria for acute to chronic health care settings. However, evaluation of physical ability in patients with hip fractures is not possible. Only grip strength can be measured.

• #81 Diagnosis and Management of Sarcopenia after Hip Fracture Surgery: Current Concept Review

  https://www.hipandpelvis.or.kr/journal/view.html?doi=10.5371/hp.2022.34.1.1

  Therefore, in the future, study of the cut-off point of the muscle mass using CT and MRI will be necessary. Development of a method for evaluating muscle mass that reflects the clinical significance and prognosis after surgery is also important. […] Previous studies have reported on the usefulness of the SARC-F questionnaire for screening sarcopenia in community dwellings. […] For evaluation of their muscle functions, our only choice is to rely on questionnaire-based methods for evaluation of gait including Koval score. […] Although validation studies on patients with hip fractures were published, very low specificity was reported for the SARC-F questionnaire. Therefore, development of a specialized questionnaire item that can predict the decrease of muscle function in patients with hip fractures is necessary. […] The global prevalence of sarcopenia in patients with hip fractures is statistically significant. Although various therapeutic agents and diagnostic criteria have been established for osteoporosis, there are no clear, useful criteria for diagnosis of sarcopenia in the clinical field.

• #82 Diagnosis and Management of Sarcopenia after Hip Fracture Surgery: Current Concept Review

  https://www.hipandpelvis.or.kr/journal/view.html?doi=10.5371/hp.2022.34.1.1

  Therefore, in the future, study of the cut-off point of the muscle mass using CT and MRI will be necessary. Development of a method for evaluating muscle mass that reflects the clinical significance and prognosis after surgery is also important. […] Previous studies have reported on the usefulness of the SARC-F questionnaire for screening sarcopenia in community dwellings. […] For evaluation of their muscle functions, our only choice is to rely on questionnaire-based methods for evaluation of gait including Koval score. […] Although validation studies on patients with hip fractures were published, very low specificity was reported for the SARC-F questionnaire. Therefore, development of a specialized questionnaire item that can predict the decrease of muscle function in patients with hip fractures is necessary. […] The global prevalence of sarcopenia in patients with hip fractures is statistically significant. Although various therapeutic agents and diagnostic criteria have been established for osteoporosis, there are no clear, useful criteria for diagnosis of sarcopenia in the clinical field.

• #83 Hip Fractures – OrthoInfo – AAOS

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

  Hip fractures can be very painful. For this reason, prompt surgical treatment is recommended. Treating the fracture and getting the patient out of bed as soon as possible will help prevent medical complications such as bed sores, blood clots, and pneumonia. […] Imaging studies will help confirm the diagnosis and provide more information about the fracture. […] Most hip fractures require surgical treatment within 1 to 2 days of injury. […] Surgical treatment is required to relieve the acute pain of the fracture and to allow the patient to get out of bed. […] Treatment for a hip fracture depends upon the type and location of the fracture, as well as the age and condition of the patient. […] Most patients are able to get of bed and start physical therapy the day after surgery. It is important to begin moving as soon as possible. This helps prevent medical complications, such as blood clots, pneumonia, and bed sores. […] Early movement and rehabilitation have been shown to improve long-term results.

• #84 Hip Fractures – OrthoInfo – AAOS

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

  Hip fractures can be very painful. For this reason, prompt surgical treatment is recommended. Treating the fracture and getting the patient out of bed as soon as possible will help prevent medical complications such as bed sores, blood clots, and pneumonia. […] Imaging studies will help confirm the diagnosis and provide more information about the fracture. […] Most hip fractures require surgical treatment within 1 to 2 days of injury. Only a very small group of nondisplaced fractures in healthy patients can be treated without surgery, while a separate small group of patients may be too sick to safely have surgery. […] Surgical treatment is required to relieve the acute pain of the fracture and to allow the patient to get out of bed. Having surgery as soon as possible can lessen the risk of complications.

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

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

  Plain radiography should be the initial diagnostic test in patients with suspected hip fracture. […] If radiography is negative and a hip fracture is still suspected, magnetic resonance imaging or a bone scan should be performed. […] When an older person presents with hip pain after a fall, he or she should be treated as if a hip fracture has occurred, until proven otherwise. […] Plain radiography is the initial diagnostic test for hip fracture. […] The timing of surgery may affect the eventual outcome. Early surgery (within 24 to 48 hours) is prudent. […] The consulting orthopedic surgeon determines the most appropriate surgical procedure. For femoral neck fractures, there is debate as to whether open reduction and internal fixation or arthroplasty is the better treatment.

• #86 Understanding Hip Fractures: Diagnosis and Treatment – Sanara MedTech

  https://sanaramedtech.com/blog/understanding-hip-fractures-diagnosis-and-treatment/

  Hip fractures are common, especially in older adults, and require timely medical and surgical intervention. […] Hip fractures are a medical emergency, and delayed treatment can lead to severe consequences. […] The mortality after hip fracture in an elderly patient remains high. This ranges between 15% to 35% within the first year. […] Prompt surgical intervention, within 24 hours, reduces the risk of these complications and improves outcomes. […] Understanding the types of hip fractures and the various treatment options available is essential for guiding patients through their recovery. […] Treatment of hip fractures is influenced by the patients age, overall health, and the type of fracture. Surgery is the most common treatment for hip fractures to restore mobility, functional alignment, and reduce the risk of complications.

• #87 Understanding Hip Fractures: Diagnosis and Treatment – Sanara MedTech

  https://sanaramedtech.com/blog/understanding-hip-fractures-diagnosis-and-treatment/

  Hip fractures are common, especially in older adults, and require timely medical and surgical intervention. […] Hip fractures are a medical emergency, and delayed treatment can lead to severe consequences. […] The mortality after hip fracture in an elderly patient remains high. This ranges between 15% to 35% within the first year. […] Prompt surgical intervention, within 24 hours, reduces the risk of these complications and improves outcomes. […] Understanding the types of hip fractures and the various treatment options available is essential for guiding patients through their recovery. […] Treatment of hip fractures is influenced by the patients age, overall health, and the type of fracture. Surgery is the most common treatment for hip fractures to restore mobility, functional alignment, and reduce the risk of complications.

• #88 Broken hip

  https://www.nhs.uk/conditions/broken-hip/

  A broken hip (hip fracture) is serious and needs treatment in hospital straight away. It can take several weeks or months to recover and you may not get back the same strength and movement you had before. […] A broken hip needs to be treated in hospital straight away. […] You’ll usually be given painkillers and have an X-ray to check if your hip is broken and to decide what treatment is best for you. […] Most people will need surgery to treat a broken hip. […] You’ll usually have surgery on the same day or day after you arrive at hospital. […] A broken hip usually takes several weeks or months to heal, but it can take longer. […] You’ll usually spend around 1 to 4 weeks in hospital. […] It’s important to do the exercises recommended by your physiotherapist regularly. This will help you recover and improve your strength and movement.

• #89 Hip Fractures: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/hip-fractures.html

  Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. […] Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. […] Cross-table lateral hip and anteroposterior pelvis radiography are the initial diagnostic tests for hip fracture. […] Magnetic resonance imaging is reserved for continued suspicion of fracture despite negative plain radiography. […] Classification as intracapsular, extracapsular, displaced, or nondisplaced drives management. […] If femoral neck stress fracture is suspected, nonweight-bearing status and complete activity cessation are recommended while awaiting definitive imaging to reduce risk of conversion to complete fracture.

• #90 What Is A Stress Fracture Of The Hip?: Sports Medicine Oregon: Orthopedic Surgery

  https://www.sportsmedicineoregon.com/blog/what-is-a-stress-fracture-of-the-hip

  A stress fracture usually occurs when a bone is subjected to repetitive strain or impact. […] The diagnosis of a hip stress fracture will be confirmed by an X-ray, or, if the fracture is difficult to find, a bone scan or MRI. […] Pain in the hip or groin should not be ignored, especially if an individual is regularly engaged in rigorous physical activity. If the pain does not cease after rest, or pain reoccurs after putting weight or stress on the hip, it is time to consult an orthopedic physician.

• #91 Hip Fractures – OrthoInfo – AAOS

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

  Hip fractures can be very painful. For this reason, prompt surgical treatment is recommended. Treating the fracture and getting the patient out of bed as soon as possible will help prevent medical complications such as bed sores, blood clots, and pneumonia. […] Imaging studies will help confirm the diagnosis and provide more information about the fracture. […] Most hip fractures require surgical treatment within 1 to 2 days of injury. […] Surgical treatment is required to relieve the acute pain of the fracture and to allow the patient to get out of bed. […] Treatment for a hip fracture depends upon the type and location of the fracture, as well as the age and condition of the patient. […] Most patients are able to get of bed and start physical therapy the day after surgery. It is important to begin moving as soon as possible. This helps prevent medical complications, such as blood clots, pneumonia, and bed sores. […] Early movement and rehabilitation have been shown to improve long-term results.

• #92 Hip Fractures – OrthoInfo – AAOS

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

  Treatment for a hip fracture depends upon the type and location of the fracture, as well as the age and condition of the patient. […] Most patients are able to get of bed and start physical therapy the day after surgery. It is important to begin moving as soon as possible. This helps prevent medical complications, such as blood clots, pneumonia, and bed sores. […] Early movement and rehabilitation have been shown to improve long-term results.

• #93 Hip Fractures: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/hip-fractures.html

  Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. […] Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. […] Cross-table lateral hip and anteroposterior pelvis radiography are the initial diagnostic tests for hip fracture. […] Magnetic resonance imaging is reserved for continued suspicion of fracture despite negative plain radiography. […] Classification as intracapsular, extracapsular, displaced, or nondisplaced drives management. […] If femoral neck stress fracture is suspected, nonweight-bearing status and complete activity cessation are recommended while awaiting definitive imaging to reduce risk of conversion to complete fracture.

• #94 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. […] To diagnose a hip fracture, your doctor will use a physical examination and imaging tests. […] X-rays are used to evaluate the location and severity of the broken bone. […] If multiple cracks exist, a CT(Computed Tomography) scan is often ordered to help plan treatment and surgery. […] Sometimes an MRI is ordered for small fractures or to help diagnose stress fractures that do not show up on plain x-rays. […] 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.

• #95 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. […] Complications can occur with hip fracture surgery. […] The risk is much bigger for larger and more contaminated traumatic wounds. […] Most people with hip fractures do very well and return to prior activities and function.

• #96 Understanding Hip Fractures: Diagnosis and Treatment – Sanara MedTech

  https://sanaramedtech.com/blog/understanding-hip-fractures-diagnosis-and-treatment/

  Internal fixation involves stabilizing the fractured bone with devices such as a long rod (nail), or a large hip screw with a side plate construct. […] In displaced femoral neck fractures, a joint replacement may be the preferred option. […] Joint replacement offers benefits such as immediate stability and the ability to bear weight sooner, which can aid in quicker rehabilitation. […] Recovery time varies based on the type of surgery performed, the patients health, and adherence to rehabilitation protocols. […] Wound healing can be significantly slower in elderly patients due to the natural aging process, which decreases the bodys ability to produce wound healing factors. […] Hip fractures are complex injuries that require individualized but prompt treatment approaches. […] Understanding the types of fractures and the available treatments will empower healthcare professionals to guide patients through the process of recovery and rehabilitation.

• #97 Hip fracture: diagnosis, treatment, and secondary prevention – PubMed

  https://pubmed.ncbi.nlm.nih.gov/25162161/

  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. Patients with hip fractures have pain in the groin and are unable to bear weight on the affected extremity. During the physical examination, displaced fractures present with external rotation and abduction, and the leg will appear shortened. Plain radiography with cross-table lateral view of the hip and anteroposterior view of the pelvis usually confirms the diagnosis. If an occult hip fracture is suspected and plain radiography is normal, magnetic resonance imaging should be ordered. […] Most fractures are treated surgically unless the patient has significant comorbidities or reduced life expectancy. The consulting orthopedic surgeon will choose the surgical procedure.

• #98 Femoral neck fractures | Joint-surgeon.com

  https://www.joint-surgeon.com/orthopedic-services/hip-surgery/femoral-neck-fracture

  A femoral neck fracture is determined by the orthopaedic hip specialist. […] Early diagnosis and treatment of a femoral neck fracture is therefore very important. […] If pain arises in the hip joint after a fall, an evaluation by an orthopaedic hip specialist is strongly advised. […] Only a physical examination and X-rays by a specialised orthopaedist will provide assurance and information on the exact location of the fracture. […] Orthopaedic treatment is based on numerous specific circumstances the hip specialist must consider. […] The goal of orthopaedic treatment is for the physician to quickly stabilise the fracture and spare the often older patient long periods of complete immobility. […] A femoral neck fracture is rarely treated conservatively. […] Although conservative or hip-preserving treatments seemingly avoid surgical risks, they are not without risk.

• #99

  https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-femur/further-reading/patient-assessment

  Consider the history of the injury. […] A femoral neck fracture is intracapsular and will have less external rotation of the leg. […] Trochanteric fractures allow greater external rotation of the leg. […] For proper radiological evaluation, x-rays in two planes at 90 to one another are necessary. […] If the trauma plain films show a potentially unstable fracture but do not give enough detail about the fracture morphology, 3-D CT imaging is a powerful tool for better diagnosis and planning for surgery. […] Plain x-rays are often sufficient to diagnose simple trochanteric fractures. […] CT imaging is the better option in this case. […] In the following cases, CT imaging is recommended: Difficulty identifying the primary fracture line, Lateral wall broken, Additional anterior cortical fragment, Intertrochanteric fracture with comminution.

• #100

  https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-femur/further-reading/patient-assessment

  An undisplaced fracture may also be referred to as occult fracture as it is not well visible in an x-ray and may not be diagnosed correctly. […] If clinical assessment indicates a neck fracture, but the x-ray does not show clear signs of it, CT or MRI imaging is recommended. […] Displaced femoral neck fractures show disruption of the medial and lateral cortical line in the AP x-ray. […] 3-D CT imaging is highly recommended to understand the morphology of the fracture and comminution. […] CT is standard imaging as it provides the most accurate information of the fracture. […] In combined fractures of the greater trochanter, the femoral head and neck, and/or the posterior wall of the acetabulum, CT imaging is necessary for recognizing the fracture pattern, decision making, and preoperative planning.

• #101

  https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/proximal-femur/further-reading/patient-assessment

  An undisplaced fracture may also be referred to as occult fracture as it is not well visible in an x-ray and may not be diagnosed correctly. […] If clinical assessment indicates a neck fracture, but the x-ray does not show clear signs of it, CT or MRI imaging is recommended. […] Displaced femoral neck fractures show disruption of the medial and lateral cortical line in the AP x-ray. […] 3-D CT imaging is highly recommended to understand the morphology of the fracture and comminution. […] CT is standard imaging as it provides the most accurate information of the fracture. […] In combined fractures of the greater trochanter, the femoral head and neck, and/or the posterior wall of the acetabulum, CT imaging is necessary for recognizing the fracture pattern, decision making, and preoperative planning.

• #102 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/9bc98f12b43c9174123d82eeb6e9c857

  Most hip fractures are treated in one of three ways: with metal pins, with a metal plate and screws, or replacing the broken femoral head with an artificial implant. […] The complications that can develop after a hip fracture are what make the injury a life-threatening problem. Some complications can result from surgery, but many can occur whether the fracture is treated with surgery or not. […] Getting the patient out of bed and moving can reduce the risk of developing all these complications. If an operation is necessary to stabilize the fracture and get the patient out of bed quickly, this will actually reduce the overall risk of developing these complications.

• #103 Hip Fracture | PM&R KnowledgeNow

  https://now.aapmr.org/hip-fracture/

  Depression, apathy, and cognitive impairments effect hip fracture patients participation in therapy. […] Pain management with opioid protocol has shown 9% risk reduction of chronic pain incidence and improved physical function at 6 months. […] Thromboembolism is a common occurrence in hip fracture patients. […] Clinicians should observe for complications such as infection, hematoma or dehiscence at site of incision. […] Fall risk is due to post-operative weakness and mobility deficits. […] Weight bearing restrictions (e.g., nonweight bearing, toe-touch (25% of body weight), or partial weight bearing) may sometimes be utilized after surgery. […] Impaired mobility is relative decrease in ability to ambulate and transfer from surfaces and commonly occurs after hip surgery. […] Non-progression with therapy is an unfortunate occurrence in rehab facilities.

• #104 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). […] X-rays are usually diagnostic, but an MRI may be required to diagnose occult fractures or pathologic fractures. […] Obtain hip and pelvis x-rays and other hip fracture diagnostics as needed. […] Suspect occult fracture despite normal x-rays in patients with characteristic clinical features of hip fracture. […] Diagnostics for osteoporosis (e.g., to establish a pretreatment baseline) […] Preoperative cardiac assessment (e.g., echocardiogram, ECG, cardiac biomarkers) based on individual risk. […] Hip x-ray (AP with internal rotation and lateral view; should include the proximal thigh) : abnormal trabecular pattern, cortical defects, shortening and angulation of the femoral neck.

• #105 Hip Fracture | PM&R KnowledgeNow

  https://now.aapmr.org/hip-fracture/

  Depression, apathy, and cognitive impairments effect hip fracture patients participation in therapy. […] Pain management with opioid protocol has shown 9% risk reduction of chronic pain incidence and improved physical function at 6 months. […] Thromboembolism is a common occurrence in hip fracture patients. […] Clinicians should observe for complications such as infection, hematoma or dehiscence at site of incision. […] Fall risk is due to post-operative weakness and mobility deficits. […] Weight bearing restrictions (e.g., nonweight bearing, toe-touch (25% of body weight), or partial weight bearing) may sometimes be utilized after surgery. […] Impaired mobility is relative decrease in ability to ambulate and transfer from surfaces and commonly occurs after hip surgery. […] Non-progression with therapy is an unfortunate occurrence in rehab facilities.

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

  https://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. […] The most common treatment is an intramedullary nail placed through a small incision at the hip or knee. […] It is important to choose your surgeon wisely. […] After surgery, patients are often allowed to bear weight immediately. […] Complications can occur with hip fracture surgery. […] Infection is a risk with any surgery, no matter how small. […] Blood clots is a common risk that can develop in the legs and go to the lungs. […] Most people with hip fractures do very well and return to prior activities and function.

• #107 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/9bc98f12b43c9174123d82eeb6e9c857

  If the hip continues to hurt and the doctor is suspicious that a hip fracture is present, magnetic resonance imaging (MRI) may be suggested. The MRI scanner uses magnetic waves rather than radiation to take multiple pictures of the hip bones. The MRI machine is very sensitive and can show fractures that do not show up on regular X-rays. […] The treatment for a hip fracture begins immediately by making sure the patient is medically stable. Once the doctor is sure that the patient is stable, decisions concerning the treatment of the fracture can be made. […] Nearly all hip fractures in the elderly are treated with some type of surgical operation to fix the fractured bones. If possible, the surgery is normally done within 24 hours of admission to the hospital. […] The goal of any surgical procedure to treat a fractured hip is to hold the broken bones securely in position, allowing the patient to get out of bed as soon as possible.

• #108 Femoral neck fractures | Joint-surgeon.com

  https://www.joint-surgeon.com/orthopedic-services/hip-surgery/femoral-neck-fracture

  In most cases, the orthopaedist will decide to operate on the femoral neck fracture. […] Aftercare is a crucial part of the healing process. […] Early mobilisation is particularly important in the aftercare of femoral neck fractures. […] If the patient is fit, they can even walk their first steps. […] Falling onto the hip can cause the cartilage in the hip joint to tear. […] Traditional diagnostic X-rays do not detect cartilage injuries. Only modern procedures such as hip arthroscopy and MRI, allow the orthopaedic specialist to detect injury to the cartilage and the joint surface.

• #109 Hip Fracture | PM&R KnowledgeNow

  https://now.aapmr.org/hip-fracture/

  Although the continuum of hip fracture rehabilitation can be undertaken by an Inpatient Rehabilitation Facility (IRF), sub-acute rehabilitation (also known as SNF, skilled nursing facility), home based rehabilitation to outpatient rehabilitation, there is strong evidence supporting the superiority of IRF-based rehabilitation. […] IRFs optimize hip fracture rehabilitation by a comprehensive team of physicians, nurses, physical occupational therapists, social and case workers. […] It has been shown that hip fracture patients undergoing rehabilitation in IRFs were more likely to be discharged home after rehabilitation than patients undergoing rehabilitation in SNFs. […] IRFs track patients functional status from admission to discharge by using FIM, functional independence measure, as a standardized method to measure function.

• #110 Hip Fracture | PM&R KnowledgeNow

  https://now.aapmr.org/hip-fracture/

  Depression, apathy, and cognitive impairments effect hip fracture patients participation in therapy. […] Pain management with opioid protocol has shown 9% risk reduction of chronic pain incidence and improved physical function at 6 months. […] Thromboembolism is a common occurrence in hip fracture patients. […] Clinicians should observe for complications such as infection, hematoma or dehiscence at site of incision. […] Fall risk is due to post-operative weakness and mobility deficits. […] Weight bearing restrictions (e.g., nonweight bearing, toe-touch (25% of body weight), or partial weight bearing) may sometimes be utilized after surgery. […] Impaired mobility is relative decrease in ability to ambulate and transfer from surfaces and commonly occurs after hip surgery. […] Non-progression with therapy is an unfortunate occurrence in rehab facilities.

• #111 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/9bc98f12b43c9174123d82eeb6e9c857

  As the population ages, the number of hip fractures that occur each year rises. […] The diagnosis of a hip fracture usually occurs in the emergency room. The diagnosis begins with a history and physical examination. It is important that the doctor be advised of any other medical problems the patient has so that treatment of the hip fracture can be planned. Most of the information from the history and physical examination will be used to try to evaluate the overall physical condition of the patient. Tests such as chest X-rays, blood work, and electrocardiograms may be ordered to assess the patient’s overall condition. […] X-rays are typically used to determine if a hip fracture has occurred and, if so, what type of fracture it is. The orthopedic surgeon will use the X-rays to determine if a surgical procedure will be necessary and to decide what type of procedure to suggest.

• #112 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/9bc98f12b43c9174123d82eeb6e9c857

  Most hip fractures are treated in one of three ways: with metal pins, with a metal plate and screws, or replacing the broken femoral head with an artificial implant. […] The complications that can develop after a hip fracture are what make the injury a life-threatening problem. Some complications can result from surgery, but many can occur whether the fracture is treated with surgery or not. […] Getting the patient out of bed and moving can reduce the risk of developing all these complications. If an operation is necessary to stabilize the fracture and get the patient out of bed quickly, this will actually reduce the overall risk of developing these complications.

• #113 Deep learning predicts hip fracture using confounding patient and healthcare variables | npj Digital Medicine

  https://www.nature.com/articles/s41746-019-0105-1

  We sought to disentangle the ability of a CNN to directly detect fracture versus indirectly predicting fracture by detecting confounding variables associated with fracture. […] When deep learning rare conditions, it is common to perform class balancing by downsampling normal examples, but this is generally done randomly without considering PT or HP variables. […] This loss of predictive performance indicates that the model was predicting fracture indirectly through these associated variables rather than directly measuring the image features of fracture. […] Although our model was dependent on covariates to predict fracture, the previously reported DL model for hip fracture detection by Gale et al. was not. […] DL algorithms can predict hip fracture from hip radiographs, as well as many patient and hospital process variables that are associated with fracture.

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