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Fractures of the proximal femur

Incidence

Increasingly common due to increasing elderly population

Annual incidence in UK approx 10/1000

 Age

Sex

Lifetime risk for a hip # is 15% for a woman, 5% for a man

 Geography

Increasing risk, further away from the equator

Caucasians having highest rate. Negroes in South Africa, lowest rate (? Genetic)


Predisposition

  1. Factors related to an increased risk of falls

    1. Concurrent medical illness

    2. Drugs- tranquillisers, alcohol

    3. Senile dementia/confusion

    4. Physical disability

    5. Lack of regular exercise

    6. Visual impairment

    7. Cardiac arrythmias

    8. Parkinsons disease/ other NM disease eg CVA

    9. Electrolyte imbalance

    10. Hypothermia     

  2. Factors related to a reduction in protective responses      

    1. Progressive decline with age

    2. Senile dementia and confusional states

    3. Neuromuscular disorder 

  3. Factors related to loss of local shock absorbers  

    1. Loss of muscle and fat from hip region    

  4. Factors related to loss of bone strength 

    1. Drugs- corticosteroids, anticonvulsants, thyroxine, alcohol

    2. Smoking

    3. Vit D deficiency

    4. Calcium deficiency

    5. Physical inactivity

    6. Immobility eg after CVA

    7. Low body weight

    8. Malnutrition

    9. White or asian

    10. Nulliparity

    11. Late menarche

    12. Early menopause

    13. Oopherectomy

    14. Parathyroid disease

    15. Hyperthyroidism

    16. Hypercorticolism

    17. Hypogonadism

    18. Chronic renal failure

    19. Chronic liver disease

    20. Malignant disease of bone

    21. Pagets disease

    22. Radiotherapy of the hip area


Clinical features

Rarely difficult

Elderly patient unable to walk after a fall

# may happen spontaneously

If pathological, patient may have pre fracture pain

Shortened externally rotated leg

 AP and lateral view of hip

If doubt about diagnosis- MR scan most accurate way to ascertain whether a fracture has occurred. Isotope bone scan is non specific. Waiting, mobilising and then rexraying runs the risk of displacement of an undisplaced #




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