112 - Surgery for hip fractures

Summary

The term hip fracture is used collectively to refer to fractures of the femoral neck and trochanteric region (i.e., intertrochanteric and subtrochanteric) that occur in two demographic populations: the young and the elderly. Hip fractures in the young result from high velocity trauma to normal bone, while fracture mechanism in the elderly is low velocity and usually involves underlying bone pathology (osteoporosis). Currently, there are 350 000 hip fractures per year in the USA, and this figure is expected to double by 2050. Healthcare cost of treatment of this injury is estimated at 10–15 billion dollars per year, defining it as an enormous burden to society.

Hip fractures may be managed operatively or non-operatively. Non-operative management consisting of early mobilization and adaptive training may be instituted in patients who are non-ambulatory or of unacceptable medical risk. The majority of patients, however, will require operative management to optimize the chance of meaningful functional recovery to premorbid status. Minimally displaced femoral neck fractures in the elderly and many non-displaced femoral neck fractures in the young are treated with percutaneous screw fixation. Displaced femoral neck fractures in the elderly (greater than 65 years of age) often have high complication rates with internal fixation and are best treated with prosthetic replacement. Peritrochanteric fractures are treated with rigid internal fixation according to fracture type and surgeon preference.

The operation that will be least stressful to the patient but allow early mobility and the best chance of recovery is chosen depending on the clinical situation.