Materiały źródłowe

• #1 Hip Fracture Overview – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557514/

  Hip fractures are fractures of the proximal femur and are commonly seen in the elderly population following a fall. This type of injury has a high rate of morbidity and mortality. […] The majority of hip fractures are the result of a fall in the elderly population. […] Many patients have multiple risk factors, and this, along with age-associated reduced bone quality, is the underpinning cause of most hip fractures. […] A pathological fracture is defined as a fracture caused by a disease process and not related to trauma. […] The two most frequent causes in relation to hip fractures are malignancy and bisphosphonate use. […] The blood supply to the femoral head plays an important role when deciding the management of hip fractures. […] In intracapsular fractures, these vessels can be damaged, which results in avascular necrosis of the femoral head.

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

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

  Most hip fractures occur in one of two locations on the long bone that extends from the pelvis to your knee (femur): […] The two most common types of hip fractures […] 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. […] A hip fracture can be repaired with the help of metal screws, plates and rods. In some cases, artificial replacements (prostheses) of parts of the hip joint may be necessary. […] Surgeons may recommend a full or partial hip replacement if the blood supply to the ball part of the hip joint was damaged during the fracture. That type of injury, which occurs most often in older people with femoral neck fractures, means the bone is less likely to heal properly.

• #1 Hip fractures – Knowledge @ AMBOSS

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

  Hip fractures are classified as intracapsular (femoral head, femoral neck) or extracapsular (intertrochanteric, trochanteric, or subtrochanteric). […] Hip fractures in older adults are typically low-impact injuries and are often associated with osteoporosis. […] Mechanism of injury includes falls onto the greater trochanter/lateral hip, forced lateral rotation, chronic overburdening leading to insufficiency fractures, and pathological fractures due to metastases. […] Older adults are at the highest risk of morbidity and mortality; early involvement of geriatric care specialists is recommended for these patients. […] Thromboembolism and osteonecrosis of the femoral head are common severe complications. […] Osteonecrosis of the femoral head is a significant complication associated with hip fracture-dislocations. […] Intracapsular fractures (e.g., femoral head and neck fractures) have an increased rate of nonunion which leads to AVN. […] Hip fractures have a high rate of associated morbidity and mortality in older adults.

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

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

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

• #1 Hip Fractures — Kwak Talk

  https://kwaktalk.org/ortho/2020/12/27/hip-fractures

  Proximal femur, or hip fractures are a common injury with over 250,000 cases in the US each year. They are associated with a high mortality rate with approximately one-third of patients dying within 1 year of the fracture. Hip fractures are categorized into femoral neck, trochanteric, and subtrochanteric fractures. The most common mechanism for a hip fracture is from a ground level fall on the affected hip. […] Intracapsular fractures like femoral neck fractures typically disrupt the blood supply to the femoral head and are associated with nonunion and avascular necrosis. Thus, hemi- or total hip arthroplasty is preferred over screw fixation in patients 70 with displaced femoral neck fractures to minimize these complications. […] Meanwhile, extracapsular fractures like intertrochanteric and subtrochanteric fractures have an adequate blood supply and typically heal well after fixation with plates, sliding hip screws, or intramedullary nails.

• #1 Hip Fracture-Related Emergency Department Visits, Hospitalizations and Deaths by Mechanism of Injury among Adults Aged 65 and Older, United States 2019

  https://stacks.cdc.gov/view/cdc/126881

  Objective: Describe rates of hip fracture-related emergency department (ED) visits, hospitalizations, and deaths among older adults (aged 65 years) in the United States. […] Results: In 2019, there were 318,797 ED visits, 290,130 hospitalizations, and 7731 deaths related to hip fractures among older adults. About 88% of ED visits and hospitalizations and approximately 83% of deaths related to hip fractures were caused by falls. […] Discussion: Most hip fractures among older adults are fall-related. Healthcare providers can prevent falls among their older patients by screening for fall risk, assessing modifiable risk factors, and offering evidence-based interventions.

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

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

  A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age. […] Risk increases because bones tend to weaken with age (osteoporosis). Multiple medications, poor vision and balance problems also make older people more likely to fall one of the most common causes of hip fracture. […] A severe impact, such as a car crash, can cause hip fractures in people of all ages. In older adults, a hip fracture is most often a result of a fall from a standing height. In people with very weak bones, a hip fracture can occur simply by standing on the leg and twisting. […] Bone density and muscle mass tend to decrease with age. Older people can also have problems with vision and balance, which can increase the risk of falling. […] Hip fractures occur in women about three times more often than they do in men. Women lose bone density faster than men do, in part because the drop in estrogen levels that occurs with menopause accelerates bone loss. However, men also can develop dangerously low levels of bone density.

• #1 Hip fracture – Wikipedia

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

  Low energy falls from standing are responsible for the majority of fractures in the elderly, but fall direction is also a key factor. […] Elderly individuals are also predisposed to hip fractures due to many factors that can compromise proprioception and balance, including medications, vertigo, stroke, and peripheral neuropathy.

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

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

  In our study, 49% of the patients were underweight, while only 3% were overweight or obese. […] The loss of vibration sense, reduced pain perception and absent Achilles and quadriceps reflexes also increase the hip fracture risk during falls. […] Therefore, an individuals general health status is one of the most important factors in determining whether a person will fracture their hip or not. […] We concluded that those elderly patients who are not able to live alone and walk without support have a higher fracture risk. […] The majority of the patients (94%) in our study fell to one side on their hips; therefore, we believe that, if it is possible, changing the direction of the fall by using walking assistant may be effective in decreasing the hip fracture rate. […] Environmental changes, such as eliminating floor coverings and internal steps, and using shower and toilet railings, may seem to be useful but environmental factors have minimal effects on osteoporotic hip fractures, so these practices will not be beneficial.

• #1 Hip Fractures – OrthoInfo – AAOS

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

  A hip fracture is a break in the upper portion of the femur (thighbone). Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis. […] Most hip fractures result from low-energy falls in elderly patients who have weakened or osteoporotic bone. In these patients, even a simple twisting or tripping injury may lead to a fracture. […] In some cases, the bone may be so weak that the fracture occurs spontaneously while someone is walking or standing. In this instance, it is often said that the break occurs before the fall. Spontaneous fractures usually occur in the femoral neck. […] Stress fractures or fractures from repeated impact may also occur in the femoral neck. These fractures are often seen in long distance runners, particularly military recruits in basic training. […] Fractures of the femoral head are rare and are usually the result of a high-impact injury or are part of a fracture dislocation of the hip.

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

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

  As the population of older adults increases worldwide so too does the number of hip fractures. Older adults have weaker bone and are more likely to fall due to diminished balance, medication side effects, and difficulty maneuvering around environmental hazards. […] Disruption of the blood supply to the head and neck of the femur can impair fracture healing in these structures. […] The femoral head is a sphere that is slightly flattened superiorly. The arrangement of its cancellous bone is oriented along the principal lines of stress. Most important of these arrangements are the primary medial trabeculae (which resist compression) and the primary lateral trabeculae (which resist tension). These structures enable the bone to endure the strong forces exerted across the proximal femur. As an example, a force 2.6 times body weight is transmitted across the hip in a one-legged stance.

• #1 Hip fracture – Wikipedia

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

  Hip fracture is a break that occurs in the upper part of the femur (thigh bone), at the femoral neck or (rarely) the femoral head. […] A hip fracture is usually a femoral neck fracture. Such fractures most often occur as a result of a fall. […] Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer. […] The hip joint is a ball-and-socket joint. […] When considering the biomechanics of hip fractures, it is important to examine the mechanical loads the hip experiences during low energy falls. […] The hip joint is unique in that it experiences combined mechanical loads. An axial load along the shaft of the femur results in compressive stress. Bending load at the neck of the femur causes tensile stress along the upper part of the neck and compressive stress along the lower part of the neck.

• #1 Hip fractures : understanding the mechanism and seeking prevention through prophylactic augmentation of the proximal femur – UBC Library Open Collections

  https://doi.library.ubc.ca/10.14288/1.0080758

  Introduction: In addition to having increased mortality and decreased mobility, hip fiacture patients are more likely to sustain a second hip fracture than people who have never fractured a hip. […] The secondary objective was to describe the initiation and progression of proximal femur failure during hip fracture to better understand the injury mechanism. […] In the hip fracture mechanism experiments, the four femurs were found to fail in a two stage process, with fracture initiating in the superior neck followed by a second failure in the inferior neck or intertrochanteric region. […] Summary and Conclusion: Hip fractures were seen to occur in a two stage process with failure initiating in the superior neck. […] These experiments point to the superior neck as a region of interest for the development of screening tools for hip fracture risk assessment, targeted therapy for bone strengthening and surgical prophylaxis.

• #1

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

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

• #1 Low Energy Hip Fractures in Young Adults: A Case-Series

  https://www.gavinpublishers.com/article/view/low-energy-hip-fractures-in-young-adults-a-case-series

  The prevalence of osteoporosis in spinal cord injury patients is well-studied and present in virtually all patients with paralyzed limbs. The main mechanism is based on decreased physical exercise and mechanical strain of the extremity, known as unloading. […] These extreme and rare cases stress the importance of taking a thorough medical history and perform additional diagnostics to diagnose underlying causes for atypical fractures, especially in young patients with an inadequate trauma mechanism. Osteoporosis screening should be considered routine for all proximal femoral fracture patients as well as all atypical low-energy fractures.

• #1 The pathophysiology of osteoporotic hip fracture

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

  Osteoporotic hip fractures have a profound impact on the physical health and psychosocial wellbeing of patients. […] The causes of osteoporosis and hip fracture are, however, well characterised and offer multiple opportunities both for prevention and disease management. This narrative review considers the pathophysiology of osteoporosis with particular reference to fragility fractures of the hip. […] Although osteoporosis may be caused by multiple factors, all of these are thought to act by subverting the normal physiology of healthy bone. […] A number of risk factors for reduced BMD exert their effect through subversion of the remodelling process. Indeed, osteoporosis may be seen simply as a failure of bone deposition to match the rate of resorption. […] Although many of the risk factors for osteoporosis and hip fracture identified in this review are preventable, particularly if challenged early in the lifespan. […] A greater understanding of the pathophysiology of osteoporosis is likely to inform health promotion strategies aimed both at primary and secondary prevention of this disease.

• #1 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. […] This is primarily because of a higher rate of osteoporosis. Osteoporosis (loss of bone tissue) is a disease that weakens bones. […] A hip fracture is classified by the specific area of the break and the type of break or breaks in your bone. […] A femoral neck fracture happens 1 to 2 inches from your hip joint. This type of fracture is common among older adults and can be related to osteoporosis. This type of fracture may cause a complication because the break usually cuts off the blood supply to the head of the thighbone, which forms the hip joint. […] Hip fracture is more common in older people. This is because bones become thinner and weaker from calcium loss as a person ages. This is generally due to osteoporosis.

• #1 Hip Fractures – OrthoPaedia

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

  By contrast to the femoral neck, the intertrochanteric region of the femur is well-lined with periosteum and has relatively dense cancellous bone and robust blood supply. All of these features enhance fracture healing potential. […] Hip fractures can be displaced by gravity and the pull of various muscles attached to the fracture fragments. […] Common risk factors for hip fractures in the geriatric population include osteoporosis, frailty and sarcopenia, prior fragility fractures, and medical conditions associated with an elevated risk for falling, such as neurologic disease, use of sedating medications and visual impairment. […] While bisphosphonates decrease the risk of hip fracture among patients with osteoporosis, these drugs do not appear to prevent fracture in those with normal bone mineral density. […] One of the most predictive factors for a future fragility fracture is a prior fragility fracture.

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

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

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

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

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

  CT studies in Japanese women with osteoporosis have shown that 2 years of zoledronate therapy had greater effects in the hip than in the femoral shaft, with significant increases in cortical thickness and volumetric bone mineral density at the femoral neck and intertrochanteric region compared with baseline. […] But zoledronate did not increase femoral shaft cortical thickness and caused only a minor increase in femoral shaft volumetric bone mineral density. Fracture patterns may have depended on damage and effects of bone turnover on mass and structure. […] This hypothetical scenario portrays a possible hip survival bias mechanism for atypical femoral fracture, with the association with antiresorptive drugs arising from greater stress and strain in cortical regions where these fractures occur rather than from treatment-related reductions in cortical bone strength or toughness.

• #1 Hip Fracture: Practice Essentials, Epidemiology, Functional Anatomy

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

  Femoral neck stress fractures were mainly seen in military recruits due to a triad of activity that is new, strenuous, and highly repetitive. […] Stress fractures occur in normal bone undergoing repeated submaximal stress. As the bone attempts to remodel, osteoclastic activity occurs at a greater rate than osteoblastic activity. When these cumulative forces exceed the structural strength of bone, stress fractures occur. […] Stress fractures occur mainly at the femoral neck and are classified as either tension (at the superior aspect of the femoral neck) or compression (at the inferior aspect of the femoral neck). […] Identification and initiation of treatment is imperative in attempts to avoid complications, such as avascular necrosis (AVN). AVN is more common in patients in the pediatric and adolescent age groups. This outcome is due to the precarious nature of the blood supply to the subchondral region of the femoral head, which does not stabilize until years after skeletal maturity, after which collateral flow develops. […] The blood supply to the femoral head has been studied extensively and has been found to change substantially during development. […] Fractures in this area can disrupt this delicate blood supply, leading to AVN, the most severe complication of this fracture.

• #1 Intertrochanteric Hip Fractures: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1247210-overview

  The stability of an intertrochanteric fracture is defined by the amount of contact between the proximal and distal main fragments. A two-part fracture is very stable because once the two fragments are reduced, they are impacted on each other and provide inherent stability for the implant. […] In a three-part fracture, the stability of the fracture is inversely proportional to the size of the lesser trochanteric fragment. Instability occurs when more than 50% of the calcar is affected, allowing the proximal fragment to collapse into a varus position and shorten. Therefore, a fracture is considered unstable if there is a large lesser trochanteric fragment or if the greater and the lesser trochanter are separate fracture fragments (four-part fracture). […] Another indicator of fracture stability is the intactness of the lateral trochanteric wall, the portion of the greater trochanter that extends from the vastus ridge (the attachment of the vastus lateralis) to the tip of the greater trochanter. If this wall is fractured, the fixation construct will collapse into an unacceptable position, or the implant will cut out.

• #1 Hip Fracture Overview – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557514/

  Fixation is associated with a re-operation rate of around 30% over 24 months. […] Early failure of fixation is often due to non-union or re-displacement of the fracture, while late failure is commonly the result of avascular necrosis. […] In extracapsular fractures, the blood supply to the femoral head is rarely compromised, and therefore fixation is the management of choice. […] Subtrochanteric and reverse oblique trochanteric (A3) fractures are particularly challenging fractures to manage due to their instability.

• #1 Low Energy Hip Fractures in Young Adults: A Case-Series

  https://www.gavinpublishers.com/article/view/low-energy-hip-fractures-in-young-adults-a-case-series

  Proximal femoral fractures are amongst the most common type of fractures in elderly patients. Osteoporosis is the main underlying cause of these low-energetic fractures. […] We report three cases of young patients with a low-energetic hip fracture and review the pathogenesis of these fractures. […] Known causes of osteoporosis in young adults include chronic inflammatory, endocrinal, neuromuscular, metabolic, and genetic diseases. Amongst these are anorexia nervosa, osteogenesis imperfecta and reserved load-bearing physical activity present in the reported cases. […] Osteoporosis is a known complication of anorexia nervosa. Chronic malnourishment can lead to multiaxial hormonal disturbances, increased reabsorption and insufficient mineralization of bone, causing loss of BMD. […] Osteogenesis Imperfecta (OI), also known as brittle bone disease, is the most common heritable connective tissue disorder with an incidence of approximately 1/20,000 births.

• #1 Hip Fractures: Diagnosis and Management | AAFP

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

  Hip fractures are common causes of disability, with mortality rates reaching 30% at one year. Nonmodifiable risk factors include lower socioeconomic status, older age, female sex, prior fracture, metabolic bone disease, and bony malignancy. Modifiable risk factors include low body mass index, having osteoporosis, increased fall risk, medications that increase fall risk or decrease bone mineral density, and substance use. […] If not recognized and treated, these fractures can progress to complete and displaced fractures with high rates of nonunion and avascular necrosis. […] Femoral neck stress fractures result from consistently high physical demands on normal bone or from normal physiologic loads on structurally compromised bone. […] Both mechanisms lead to overload and mechanical failure and, if not recognized early, may progress to complete and displaced hip fracture. Because of high, poor relative vascular supply of the circumflex femoral arteries around the femoral neck, these fractures carry high rates of nonunion and avascular necrosis.

• #1 Mechanisms of Hip Fracture in Owerri, Nigeria, and its Associate

  https://www.amhsr.org/articles/mechanisms-of-hip-fracture-in-owerri-nigeria-and-its-associated-variables.html

  Hip fracture has been associated with various risk factors, including osteoporosis, excessive alcohol consumption, physical inactivity, visual impairment, aging, sex, rural/urban inhabitation, race and climatic variations. […] Mechanisms of hip fractures in many parts of the world have been documented, and include road traffic accident (RTA), gunshot injury, fall from heights and many others. […] These fracture mechanisms depend on environmental factors, and vary from place to place depending on the level of development and regulations. […] Mechanism of hip fractures in Owerri, Nigeria, can be associated with gender and age. RTA had the largest single contributory mechanism of hip fractures in Owerri. […] Among the elderly population, hip fracture was mostly sustained from fragility trauma mechanisms, suggesting that osteoporosis is a major contributory factor of hip fracture among this population.

• #1 Hip Fractures – Zero To Finals

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

  Hip fractures are an important topic in trauma and orthopaedics. They are common and lead to significant morbidity and mortality. The 30-day mortality is 5-10%. Half of patients become less independent after a hip fracture. […] Increasing age and osteoporosis are major risk factors for hip fractures. Females are affected more often than males. […] A fracture of the intra-capsular neck of the femur can damage these blood vessels, removing the blood supply to the femoral head, leading to avascular necrosis. Therefore, patients with a displaced intra-capsular fracture need to have the femoral head replaced with a hemiarthroplasty or total hip replacement. […] Displaced intra-capsular fractures (grade III and IV) disrupt the blood supply to the head of the femur. Therefore, the head of the femur needs to be removed and replaced. […] Extra-capsular fractures leave the blood supply to the head of the femur intact. Therefore, the head of the femur does not need to be replaced.

• #1 Hip Fracture | Cedars-Sinai

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

  Bones affected by osteoporosis are more likely to break if you fall. […] If you are a woman, you lose 30% to 50% of your bone density as you age. The loss of bone speeds up dramatically after menopause because you make less estrogen. Estrogen contributes to maintaining bone density and strength. […] Serious complications can result from a hip fracture. […] With some fractures, blood can’t circulate properly to the head of the thigh bone. This results in a loss of blood supply to this area. This is called femoral avascular necrosis. This complication may happen, depending on the type of fracture and the anatomy of your blood supply to the head of the thigh bone. This is more common with femoral neck fractures. […] Hip fractures can result in a loss of independence, reduced quality of life, and depression. This is especially true for older people.

• #1 Neck of Femur Fracture – Subcapital – Intertrochanteric – TeachMeSurgery

  https://teachmesurgery.com/orthopaedic/hip/neck-femur-fracture/

  A fractured neck of femur (NOF) is a very common orthopaedic presentation. Over 65,000 hip fractures each year are recorded in the UK and they are becoming increasingly frequent due to an aging population. […] The mortality of a femoral neck fracture up to 30% at one year; consequently, these fractures require specialist care and, indeed, most orthopaedic units now have dedicated orthogeriatricians who specialise in the care of this vulnerable patient group. […] Neck of femur fractures are typically caused either by low energy injuries (the most common type), such as a fall in frail older patient, or high energy injuries, such as a road traffic collision or fall from height and are often associated with other significant injuries. […] Consequently, displaced intra-capsular fractures disrupt the blood supply to the femoral head and, therefore, the femoral head will undergo avascular necrosis (even if the hip is fixed). Patients with a displaced intra-capsular fracture therefore require joint replacement (arthroplasty), rather than fixation. […] Long term complications following repair include joint dislocation, aseptic loosening, peri-prosthetic fracture, and deep infection/prosthetic joint infection. The mortality following a femoral neck fracture is up to 30% at one year.

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

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

  The risk of hip fracture can be increased if you have: Osteoporosis. This condition weakens bones and makes them more likely to break. […] Cortisone medications, such as prednisone, can weaken bones if taken long-term. Certain drugs or certain combinations of medications can cause dizziness, which can increase the risk of falling. […] Lack of calcium and vitamin D in the diet of young people lowers peak bone mass and increases risk of fracture later in life. It’s also important to get enough calcium and vitamin D in older age to try to maintain bone density. […] Lack of regular weight-bearing exercise, such as walking, can result in weakened bones and muscles, making falls and fractures more likely. […] Tobacco and alcohol both can interfere with the normal processes of bone building and maintenance, resulting in bone loss.

• #1 Reduced Hip Cortical Porosity Upon Denosumab Treatment: A Likely Mechanism Contributing To The Reduction Of Hip Fracture Risk In Women With Osteoporosis – ACR Meeting Abstracts

  https://acrabstracts.org/abstract/reduced-hip-cortical-porosity-upon-denosumab-treatment-a-likely-mechanism-contributing-to-the-reduction-of-hip-fracture-risk-in-women-with-osteoporosis/

  Reduced Hip Cortical Porosity Upon Denosumab Treatment: A Likely Mechanism Contributing To The Reduction Of Hip Fracture Risk In Women With Osteoporosis […] Nonvertebral fracture risk is significantly influenced by cortical thickness, area, mass, and porosity because all of these contribute to bone strength. In particular, increased cortical porosity, a marker of structural decay, is associated with an exponential worsening in bone fragility. Cortical porosity is the result of unbalanced and accelerated intracortical remodeling upon Haversian canal surfaces which enlarge, coalesce, and fragment the cortex. […] DMAb reduced porosity compared with baseline and Pbo at year 3 across the entire cortex (Figure) and in each cortical sub-compartment, reaching treatment effect (DMAbPbo) improvements of 1.8% (inner transitional zone), 5.6% (outer transitional zone), and 7.9% (compact-appearing cortex) (all p). […] Since reductions in cortical porosity equate to increased mineralized bone matrix mass and both are relevant to strength, these improvements are expected to contribute to the observed reductions in nonvertebral fractures associated with DMAb administration.

• #2 Neck of Femur Fracture – Subcapital – Intertrochanteric – TeachMeSurgery

  https://teachmesurgery.com/orthopaedic/hip/neck-femur-fracture/

  A fractured neck of femur (NOF) is a very common orthopaedic presentation. Over 65,000 hip fractures each year are recorded in the UK and they are becoming increasingly frequent due to an aging population. […] The mortality of a femoral neck fracture up to 30% at one year; consequently, these fractures require specialist care and, indeed, most orthopaedic units now have dedicated orthogeriatricians who specialise in the care of this vulnerable patient group. […] Neck of femur fractures are typically caused either by low energy injuries (the most common type), such as a fall in frail older patient, or high energy injuries, such as a road traffic collision or fall from height and are often associated with other significant injuries. […] Consequently, displaced intra-capsular fractures disrupt the blood supply to the femoral head and, therefore, the femoral head will undergo avascular necrosis (even if the hip is fixed). Patients with a displaced intra-capsular fracture therefore require joint replacement (arthroplasty), rather than fixation. […] Long term complications following repair include joint dislocation, aseptic loosening, peri-prosthetic fracture, and deep infection/prosthetic joint infection. The mortality following a femoral neck fracture is up to 30% at one year.

• #2 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. […] This is primarily because of a higher rate of osteoporosis. Osteoporosis (loss of bone tissue) is a disease that weakens bones. […] A hip fracture is classified by the specific area of the break and the type of break or breaks in your bone. […] A femoral neck fracture happens 1 to 2 inches from your hip joint. This type of fracture is common among older adults and can be related to osteoporosis. This type of fracture may cause a complication because the break usually cuts off the blood supply to the head of the thighbone, which forms the hip joint. […] Hip fracture is more common in older people. This is because bones become thinner and weaker from calcium loss as a person ages. This is generally due to osteoporosis.

• #2 Hip Fracture Overview – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557514/

  Hip fractures are fractures of the proximal femur and are commonly seen in the elderly population following a fall. This type of injury has a high rate of morbidity and mortality. […] The majority of hip fractures are the result of a fall in the elderly population. […] Many patients have multiple risk factors, and this, along with age-associated reduced bone quality, is the underpinning cause of most hip fractures. […] A pathological fracture is defined as a fracture caused by a disease process and not related to trauma. […] The two most frequent causes in relation to hip fractures are malignancy and bisphosphonate use. […] The blood supply to the femoral head plays an important role when deciding the management of hip fractures. […] In intracapsular fractures, these vessels can be damaged, which results in avascular necrosis of the femoral head.

• #2 Hip Fracture Overview – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557514/

  Fixation is associated with a re-operation rate of around 30% over 24 months. […] Early failure of fixation is often due to non-union or re-displacement of the fracture, while late failure is commonly the result of avascular necrosis. […] In extracapsular fractures, the blood supply to the femoral head is rarely compromised, and therefore fixation is the management of choice. […] Subtrochanteric and reverse oblique trochanteric (A3) fractures are particularly challenging fractures to manage due to their instability.

• #2 Types of Hip Fractures | Stanford Health Care

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

  A hip fracture is classified by the specific area of the break and the type of break in the bone. […] A femoral neck fracture occurs one to two inches from the hip joint. These fractures are common among older adults and can be related to osteoporosis. This type of fracture may cause a complication because the break usually cuts off the blood supply to the head of the femur which forms the hip joint. […] An intertrochanteric hip fracture occurs three to four inches from the hip joint. This type of fracture does not interrupt the blood supply to the bone and may be easier to repair.

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

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

  The risk of hip fracture can be increased if you have: Osteoporosis. This condition weakens bones and makes them more likely to break. […] Cortisone medications, such as prednisone, can weaken bones if taken long-term. Certain drugs or certain combinations of medications can cause dizziness, which can increase the risk of falling. […] Lack of calcium and vitamin D in the diet of young people lowers peak bone mass and increases risk of fracture later in life. It’s also important to get enough calcium and vitamin D in older age to try to maintain bone density. […] Lack of regular weight-bearing exercise, such as walking, can result in weakened bones and muscles, making falls and fractures more likely. […] Tobacco and alcohol both can interfere with the normal processes of bone building and maintenance, resulting in bone loss.

• #2 Hip Fractures – OrthoInfo – AAOS

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

  A hip fracture is a break in the upper portion of the femur (thighbone). Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis. […] Most hip fractures result from low-energy falls in elderly patients who have weakened or osteoporotic bone. In these patients, even a simple twisting or tripping injury may lead to a fracture. […] In some cases, the bone may be so weak that the fracture occurs spontaneously while someone is walking or standing. In this instance, it is often said that the break occurs before the fall. Spontaneous fractures usually occur in the femoral neck. […] Stress fractures or fractures from repeated impact may also occur in the femoral neck. These fractures are often seen in long distance runners, particularly military recruits in basic training. […] Fractures of the femoral head are rare and are usually the result of a high-impact injury or are part of a fracture dislocation of the hip.

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

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

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

• #2 Hip fracture – Wikipedia

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

  Hip fracture is a break that occurs in the upper part of the femur (thigh bone), at the femoral neck or (rarely) the femoral head. […] A hip fracture is usually a femoral neck fracture. Such fractures most often occur as a result of a fall. […] Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer. […] The hip joint is a ball-and-socket joint. […] When considering the biomechanics of hip fractures, it is important to examine the mechanical loads the hip experiences during low energy falls. […] The hip joint is unique in that it experiences combined mechanical loads. An axial load along the shaft of the femur results in compressive stress. Bending load at the neck of the femur causes tensile stress along the upper part of the neck and compressive stress along the lower part of the neck.

• #2 Hip Fractures: Mechanism Of Injury — OrthopaedicPrinciples.com

  https://orthopaedicprinciples.com/2021/01/hip-fractures-mechanism-of-injury/

  Mechanism of injury of Hip fractures […] Low energy fracture occurs in the elderly from a fall onto the greater trochanter. […] High energy fractures occurs in both the young and elderly from either a fall or by a car accident. […] Stress fractures can occur in athletes and insufficiency fractures can occur in the elderly and it is usually an occult fracture.

• #2 Low Energy Hip Fractures in Young Adults: A Case-Series

  https://www.gavinpublishers.com/article/view/low-energy-hip-fractures-in-young-adults-a-case-series

  Proximal femoral fractures are amongst the most common type of fractures in elderly patients. Osteoporosis is the main underlying cause of these low-energetic fractures. […] We report three cases of young patients with a low-energetic hip fracture and review the pathogenesis of these fractures. […] Known causes of osteoporosis in young adults include chronic inflammatory, endocrinal, neuromuscular, metabolic, and genetic diseases. Amongst these are anorexia nervosa, osteogenesis imperfecta and reserved load-bearing physical activity present in the reported cases. […] Osteoporosis is a known complication of anorexia nervosa. Chronic malnourishment can lead to multiaxial hormonal disturbances, increased reabsorption and insufficient mineralization of bone, causing loss of BMD. […] Osteogenesis Imperfecta (OI), also known as brittle bone disease, is the most common heritable connective tissue disorder with an incidence of approximately 1/20,000 births.

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

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

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

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

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

  Changes in the skeletal geometry of the lower limb such as femoral neck-shaft angle and femoral curvature alter the stresses and strains experienced by the femoral diaphysis with loading. Because the incidence of incomplete atypical femoral fracture is much greater than that of complete fracture, most incomplete atypical femoral fractures heal before the fracture progresses. […] Ultimately, all fractures, including atypical femoral fractures, occur when mechanical stress and strain exceed bone strength. […] Antiresorptive drugs such as bisphosphonates, estrogen, calcitonin, and RANK ligand inhibitors prevent hip fracture by increasing the strength of the proximal femur perhaps at the expense of the strength (or toughness) of the subtrochanteric shaft. […] It is also possible that treatment-related increases in hip strength (and reduced hip fracture rates) promote or sustain the transfer of stress and strain to femoral regions that experience lesser or no increases in strength from treatment, which likely includes the shaft.

• #2 Hip Fracture | Cedars-Sinai

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

  Bones affected by osteoporosis are more likely to break if you fall. […] If you are a woman, you lose 30% to 50% of your bone density as you age. The loss of bone speeds up dramatically after menopause because you make less estrogen. Estrogen contributes to maintaining bone density and strength. […] Serious complications can result from a hip fracture. […] With some fractures, blood can’t circulate properly to the head of the thigh bone. This results in a loss of blood supply to this area. This is called femoral avascular necrosis. This complication may happen, depending on the type of fracture and the anatomy of your blood supply to the head of the thigh bone. This is more common with femoral neck fractures. […] Hip fractures can result in a loss of independence, reduced quality of life, and depression. This is especially true for older people.

• #2 Intertrochanteric Hip Fractures: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1247210-overview

  The more unstable the fracture is, the more difficult reduction will be, and the more likely it is that an implant, such as a cephalomedullary nail, will be needed to stabilize the fracture and prevent collapse. Stable fractures can be treated with a sliding hip screwplate device (two- to four-hole plate).

• #2 Mechanisms of Hip Fracture in Owerri, Nigeria, and its Assoc | 2525

  https://www.amhsr.org/abstract/mechanisms-of-hip-fracture-in-owerri-nigeria-and-its-associated-variables-2525.html

  Hip fracture has been associated with various risk factors, including osteoporosis, excessive alcohol consumption, physical inactivity, visual impairment, aging, sex, rural/urban inhabitation, race and climatic variations. […] Mechanisms of hip fractures in many parts of the world have been documented, and include road traffic accident (RTA), gunshot injury, fall from heights and many others. […] Mechanism of hip fractures in Owerri, Nigeria, can be associated with gender and age. RTA had the largest single contributory mechanism of hip fractures in Owerri. […] Among the elderly population, hip fracture was mostly sustained from fragility trauma mechanisms, suggesting that osteoporosis is a major contributory factor of hip fracture among this population.

• #2

  https://mjm.mcgill.ca/article/view/410

  Osteoporotic hip fractures have a profound impact on the physical health and psychosocial wellbeing of patients. […] This narrative review explores the pathological process underlying osteoporosis and considers how each of the major risk factors contributes to the pathology of this disease. […] It is hoped that a greater understanding of individual risk factors will result in renewed efforts to promote increased bone density before patients present with hip fracture. […] Seeman E. Pathogenesis of bone fragility in women and men. Lancet 359:1841-1850; 2002.

• #2 Hip Fractures — Kwak Talk

  https://kwaktalk.org/ortho/2020/12/27/hip-fractures

  Proximal femur, or hip fractures are a common injury with over 250,000 cases in the US each year. They are associated with a high mortality rate with approximately one-third of patients dying within 1 year of the fracture. Hip fractures are categorized into femoral neck, trochanteric, and subtrochanteric fractures. The most common mechanism for a hip fracture is from a ground level fall on the affected hip. […] Intracapsular fractures like femoral neck fractures typically disrupt the blood supply to the femoral head and are associated with nonunion and avascular necrosis. Thus, hemi- or total hip arthroplasty is preferred over screw fixation in patients 70 with displaced femoral neck fractures to minimize these complications. […] Meanwhile, extracapsular fractures like intertrochanteric and subtrochanteric fractures have an adequate blood supply and typically heal well after fixation with plates, sliding hip screws, or intramedullary nails.

• #2 Hip fractures : understanding the mechanism and seeking prevention through prophylactic augmentation of the proximal femur – UBC Library Open Collections

  https://doi.library.ubc.ca/10.14288/1.0080758

  Introduction: In addition to having increased mortality and decreased mobility, hip fiacture patients are more likely to sustain a second hip fracture than people who have never fractured a hip. […] The secondary objective was to describe the initiation and progression of proximal femur failure during hip fracture to better understand the injury mechanism. […] In the hip fracture mechanism experiments, the four femurs were found to fail in a two stage process, with fracture initiating in the superior neck followed by a second failure in the inferior neck or intertrochanteric region. […] Summary and Conclusion: Hip fractures were seen to occur in a two stage process with failure initiating in the superior neck. […] These experiments point to the superior neck as a region of interest for the development of screening tools for hip fracture risk assessment, targeted therapy for bone strengthening and surgical prophylaxis.

• #3 Hip Fractures — Kwak Talk

  https://kwaktalk.org/ortho/2020/12/27/hip-fractures

  Proximal femur, or hip fractures are a common injury with over 250,000 cases in the US each year. They are associated with a high mortality rate with approximately one-third of patients dying within 1 year of the fracture. Hip fractures are categorized into femoral neck, trochanteric, and subtrochanteric fractures. The most common mechanism for a hip fracture is from a ground level fall on the affected hip. […] Intracapsular fractures like femoral neck fractures typically disrupt the blood supply to the femoral head and are associated with nonunion and avascular necrosis. Thus, hemi- or total hip arthroplasty is preferred over screw fixation in patients 70 with displaced femoral neck fractures to minimize these complications. […] Meanwhile, extracapsular fractures like intertrochanteric and subtrochanteric fractures have an adequate blood supply and typically heal well after fixation with plates, sliding hip screws, or intramedullary nails.

• #3 Hip Fractures: Diagnosis and Management | AAFP

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

  Hip fractures are common causes of disability, with mortality rates reaching 30% at one year. Nonmodifiable risk factors include lower socioeconomic status, older age, female sex, prior fracture, metabolic bone disease, and bony malignancy. Modifiable risk factors include low body mass index, having osteoporosis, increased fall risk, medications that increase fall risk or decrease bone mineral density, and substance use. […] If not recognized and treated, these fractures can progress to complete and displaced fractures with high rates of nonunion and avascular necrosis. […] Femoral neck stress fractures result from consistently high physical demands on normal bone or from normal physiologic loads on structurally compromised bone. […] Both mechanisms lead to overload and mechanical failure and, if not recognized early, may progress to complete and displaced hip fracture. Because of high, poor relative vascular supply of the circumflex femoral arteries around the femoral neck, these fractures carry high rates of nonunion and avascular necrosis.

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

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

  To investigate the causes and occurrence mechanisms of osteoporotic hip fractures in elderly patients in Turkish society. […] Most fractures occur via balance disturbances without any environmental factors and the majority of the patients fall on one side, not to the front or back. […] Although osteoporosis is the most important factor in hip fractures, it is not sufficient to produce them in and of itself. A fall from a standing height is the main mechanism of injury for fractures in elderly people, although several other factors can contribute, including falls from elevated heights and traffic accidents. […] The fractures occurred most often at home via balance disturbances, without any associated environmental factors, and the majority of the patients fell on one side. […] Body weight is an important factor in the occurrence of an osteoporotic hip fracture after falling down.

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

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

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

• #3 Hip Fracture | Cedars-Sinai

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

  Bones affected by osteoporosis are more likely to break if you fall. […] If you are a woman, you lose 30% to 50% of your bone density as you age. The loss of bone speeds up dramatically after menopause because you make less estrogen. Estrogen contributes to maintaining bone density and strength. […] Serious complications can result from a hip fracture. […] With some fractures, blood can’t circulate properly to the head of the thigh bone. This results in a loss of blood supply to this area. This is called femoral avascular necrosis. This complication may happen, depending on the type of fracture and the anatomy of your blood supply to the head of the thigh bone. This is more common with femoral neck fractures. […] Hip fractures can result in a loss of independence, reduced quality of life, and depression. This is especially true for older people.

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

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

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

• #3 Hip Fractures – Zero To Finals

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

  Hip fractures are an important topic in trauma and orthopaedics. They are common and lead to significant morbidity and mortality. The 30-day mortality is 5-10%. Half of patients become less independent after a hip fracture. […] Increasing age and osteoporosis are major risk factors for hip fractures. Females are affected more often than males. […] A fracture of the intra-capsular neck of the femur can damage these blood vessels, removing the blood supply to the femoral head, leading to avascular necrosis. Therefore, patients with a displaced intra-capsular fracture need to have the femoral head replaced with a hemiarthroplasty or total hip replacement. […] Displaced intra-capsular fractures (grade III and IV) disrupt the blood supply to the head of the femur. Therefore, the head of the femur needs to be removed and replaced. […] Extra-capsular fractures leave the blood supply to the head of the femur intact. Therefore, the head of the femur does not need to be replaced.

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

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

  Hip fractures usually occur in older adults and often result from a minor fall, particularly in people with osteoporosis. […] Most hip fractures result from falls, but in older adults with osteoporosis, the stresses of ordinary activity such as rolling over in bed, getting up from a chair, or walking can break the hip. […] Femoral neck hip fractures are particularly problematic because the fracture often disrupts the blood supply to the head of the bone. Without a good blood supply, the bone cannot grow back together, and it may eventually collapse and die (called osteonecrosis). Severe, painful arthritis may develop. […] Intertrochanteric hip fractures rarely interrupt the blood supply to the head of the femur. The broken surface of the bone may bleed but not usually enough to cause serious problems.

• #3 Neck of Femur Fracture – Subcapital – Intertrochanteric – TeachMeSurgery

  https://teachmesurgery.com/orthopaedic/hip/neck-femur-fracture/

  A fractured neck of femur (NOF) is a very common orthopaedic presentation. Over 65,000 hip fractures each year are recorded in the UK and they are becoming increasingly frequent due to an aging population. […] The mortality of a femoral neck fracture up to 30% at one year; consequently, these fractures require specialist care and, indeed, most orthopaedic units now have dedicated orthogeriatricians who specialise in the care of this vulnerable patient group. […] Neck of femur fractures are typically caused either by low energy injuries (the most common type), such as a fall in frail older patient, or high energy injuries, such as a road traffic collision or fall from height and are often associated with other significant injuries. […] Consequently, displaced intra-capsular fractures disrupt the blood supply to the femoral head and, therefore, the femoral head will undergo avascular necrosis (even if the hip is fixed). Patients with a displaced intra-capsular fracture therefore require joint replacement (arthroplasty), rather than fixation. […] Long term complications following repair include joint dislocation, aseptic loosening, peri-prosthetic fracture, and deep infection/prosthetic joint infection. The mortality following a femoral neck fracture is up to 30% at one year.

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

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

  Most hip fractures occur in one of two locations on the long bone that extends from the pelvis to your knee (femur): […] The two most common types of hip fractures […] 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. […] A hip fracture can be repaired with the help of metal screws, plates and rods. In some cases, artificial replacements (prostheses) of parts of the hip joint may be necessary. […] Surgeons may recommend a full or partial hip replacement if the blood supply to the ball part of the hip joint was damaged during the fracture. That type of injury, which occurs most often in older people with femoral neck fractures, means the bone is less likely to heal properly.

• #4 Hip fractures – Knowledge @ AMBOSS

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

  Hip fractures are classified as intracapsular (femoral head, femoral neck) or extracapsular (intertrochanteric, trochanteric, or subtrochanteric). […] Hip fractures in older adults are typically low-impact injuries and are often associated with osteoporosis. […] Mechanism of injury includes falls onto the greater trochanter/lateral hip, forced lateral rotation, chronic overburdening leading to insufficiency fractures, and pathological fractures due to metastases. […] Older adults are at the highest risk of morbidity and mortality; early involvement of geriatric care specialists is recommended for these patients. […] Thromboembolism and osteonecrosis of the femoral head are common severe complications. […] Osteonecrosis of the femoral head is a significant complication associated with hip fracture-dislocations. […] Intracapsular fractures (e.g., femoral head and neck fractures) have an increased rate of nonunion which leads to AVN. […] Hip fractures have a high rate of associated morbidity and mortality in older adults.

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