Hip Fractures
Overview:
Hip fracture is the most common name given to a fracture of the proximal femur. There are different types based on the area of the fracture on the bone:
Causes/Risk Factors/Pathogenesis:
In the Adolescent population, the most common cause of hip fracture is blunt trauma to the hip region that provides enough stress to fracture the femur. However other factors can place an individual at greater risk including: participation in high impact sports, type II diabetes, female athlete triad, and osteoporosis. Additional risk factors include: soft tissue damage, avascular necrosis of the femoral head
Clinical Presentation:
Individuals with a hip fracture typically present with the following: severe unilateral hip pain, inability to weight bear or ambulate on the involved lower extremity, Active/Passive range of motion restrictions secondary to pain, tenderness and swelling over the femoral neck/trochanter area, involved lower extremity held in abduction and external rotation
Examination:
--History - A careful subjective history of the causative incident, and current patient presentation should provide adequate information to allow for fracture consideration
--Diagnostic Tests/Imaging/Tests and Measures -
Differential Diagnosis:
Other hip pathology to rule out include: Labral tears, acetabular fracture, Slipped capital femoral epiphysis, Legg-Calve Perthes disease, Pubis symphysis separation, severe groin muscle strain
Clinical Bottom Line:
If a hip fracture is suspected, the patient should be immediately referred to the nearest Emergency Room for imaging and further evaluation and treatment with instructions to limit movement of the involved lower extremity to avoid increased damage to the area
See Hip Fracture References
Hip fracture is the most common name given to a fracture of the proximal femur. There are different types based on the area of the fracture on the bone:
- Femoral Neck: the fracture is located distal to the femoral head and proximal to the greater and lesser trochanters and is an intercapsular fracture
- Intertrochanteric: the fracture is located between the greater and lesser trochanters and is an extracapsular fracture
- Subtrochanteric: the fracture is distal to the lesser trochanter on the main shaft of the proximal femur
Causes/Risk Factors/Pathogenesis:
In the Adolescent population, the most common cause of hip fracture is blunt trauma to the hip region that provides enough stress to fracture the femur. However other factors can place an individual at greater risk including: participation in high impact sports, type II diabetes, female athlete triad, and osteoporosis. Additional risk factors include: soft tissue damage, avascular necrosis of the femoral head
Clinical Presentation:
Individuals with a hip fracture typically present with the following: severe unilateral hip pain, inability to weight bear or ambulate on the involved lower extremity, Active/Passive range of motion restrictions secondary to pain, tenderness and swelling over the femoral neck/trochanter area, involved lower extremity held in abduction and external rotation
Examination:
--History - A careful subjective history of the causative incident, and current patient presentation should provide adequate information to allow for fracture consideration
--Diagnostic Tests/Imaging/Tests and Measures -
- Hip range of motion (active and passive)
- Assessment of muscle strength (assess for reflex inhibition and general weakness especially of the hip abductors)
- Lower extremity neurological and vascular screening
- Patellar-Pubic Percussion Test -- Watch Video
- Assess skin integrity/need for wound care if an open fracture
- X-ray radiography or MRI (X-rays may indicate a false negative up to 3 days post-incident; MRIs are typically able to rule a fracture in/out 1 day post-incident)
Differential Diagnosis:
Other hip pathology to rule out include: Labral tears, acetabular fracture, Slipped capital femoral epiphysis, Legg-Calve Perthes disease, Pubis symphysis separation, severe groin muscle strain
Clinical Bottom Line:
If a hip fracture is suspected, the patient should be immediately referred to the nearest Emergency Room for imaging and further evaluation and treatment with instructions to limit movement of the involved lower extremity to avoid increased damage to the area
See Hip Fracture References