Hip fracture

Classically, this is a fracture of old age, often affecting women in their eighth or ninth decade of life.

Hip fracture refers to a fracture occurring in the area between the edge of the femoral head and 5 centimetres below the lesser trochanter

• these fractures are generally divided into two main groups (1)
  
  • those above the insertion of the capsule of the hip joint are termed intracapsular, subcapital or femoral neck fractures
    
  • those below the insertion are extracapsular
    • the extracapsular group is split further into trochanteric (inter- or per-trochanteric and reverse oblique) and sub-trochanteric

Usually the bone has been weakened by underlying disease - most commonly, osteoporosis but also osteomalacia, diabetes, alcoholism and other conditions associated with osteopenia.

There is usually a history of trauma but in severely weakened bone, direct injury may be trivial or absent.

Rarely, fractures of the femoral neck are seen in children.

Generally the fracture is displaced and unstable. If some of the fragments have been impacted then the patient may be able to walk with some pain and discomfort.

In the UK, around 76,000 hip fractures occur each year (2) and patients recovering from hip fracture occupy 4000 NHS beds at any one time (3). About 10% of people with a hip fracture die within 1 month and about one-third within 12 months. Most of the deaths are due to associated conditions and not to the fracture itself, reflecting the high prevalence of comorbidity (4)

Note:

• magnetic resonance imaging (MRI) should be offered if a hip fracture is suspected despite negative X-rays of the hip of an adequate standard
  • if MRI is not available within 24 hours or is contraindicated, consider computed tomography (CT)

Reference:

1. NICE. Hip fracture: management. Clinical guideline CG124. Published June 2011, last updated January 2023.
2. Royal College of Physicians. The challenge of the next decade: are hip fracture services ready? A review of data from the National Hip Fracture Database (January–December 2019). 2021 [internet publication].
3. Royal College of Physicians; AAGBI Foundation. Falls and fragility fracture audit programme national hip fracture database: anaesthesia sprint audit of practice 2014. 2014 [internet publication].
4. North American Menopause Society. Management of osteoporosis in postmenopausal women: the 2021 position statement of the North American Menopause Society. Menopause. 2021 Sep 1;28(9):973-97.