Hip Fractures: Diagnosis and Management

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...

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Veröffentlicht in:American family physician 2022-12, Vol.106 (6), p.675-683
Hauptverfasser: Schroeder, Jeremy D, Turner, Sean P, Buck, Emily
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Buck, Emily
description 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. Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. Operative management within 24 to 48 hours of the fracture optimizes outcomes. Fractures are usually managed by surgery, with the approach based on fracture type and location; spinal or general anesthesia can be used. Nonsurgical management can be considered for patients who are not good surgical candidates. Pre- and postoperative antistaphylococcal antibiotics are given to prevent joint infection. Medications for venous thromboembolism prophylaxis are also recommended. Physicians should be alert for the presence of delirium, which is a common postoperative complication. Early postoperative mobilization, followed by rehabilitation, improves outcomes. Subsequent care focuses on prevention, with increased physical activity, home safety assessments, and minimizing polypharmacy. Two less common hip fractures can also occur: femoral neck stress fractures and insufficiency fractures. Femoral neck stress fractures typically occur in dancers 20 to 30 years of age, endurance athletes, and military service members, often because of training overload. Insufficiency fractures due to compromised bone strength occur without trauma in postmenopausal women. If not recognized and treated, these fractures can progress to complete and displaced fractures with high rates of nonunion and avascular necrosis.
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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. Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. Operative management within 24 to 48 hours of the fracture optimizes outcomes. Fractures are usually managed by surgery, with the approach based on fracture type and location; spinal or general anesthesia can be used. Nonsurgical management can be considered for patients who are not good surgical candidates. Pre- and postoperative antistaphylococcal antibiotics are given to prevent joint infection. Medications for venous thromboembolism prophylaxis are also recommended. Physicians should be alert for the presence of delirium, which is a common postoperative complication. Early postoperative mobilization, followed by rehabilitation, improves outcomes. Subsequent care focuses on prevention, with increased physical activity, home safety assessments, and minimizing polypharmacy. Two less common hip fractures can also occur: femoral neck stress fractures and insufficiency fractures. Femoral neck stress fractures typically occur in dancers 20 to 30 years of age, endurance athletes, and military service members, often because of training overload. Insufficiency fractures due to compromised bone strength occur without trauma in postmenopausal women. If not recognized and treated, these fractures can progress to complete and displaced fractures with high rates of nonunion and avascular necrosis.</description><identifier>ISSN: 0002-838X</identifier><identifier>EISSN: 1532-0650</identifier><identifier>PMID: 36521464</identifier><language>eng</language><publisher>United States: American Academy of Family Physicians</publisher><subject>Alcohol use ; Antibiotics ; Body mass index ; Bone Density ; Bone diseases ; Caffeine ; Clinical medicine ; Clinical trials ; Diagnostic tests ; Diuretics ; Female ; Femoral Neck Fractures - complications ; Femoral Neck Fractures - surgery ; Fractures ; Fractures, Stress - complications ; Hemoglobin ; Hip Fractures - complications ; Hip Fractures - diagnosis ; Hip Fractures - therapy ; Humans ; Joint surgery ; Medical diagnosis ; Metabolism ; Mortality ; Orthopedics ; Osteoporosis ; Pain ; Patients ; Radiography ; Risk factors ; Socioeconomic factors ; Steroids ; Surgeons ; Vitamin D</subject><ispartof>American family physician, 2022-12, Vol.106 (6), p.675-683</ispartof><rights>2022. 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Pre- and postoperative antistaphylococcal antibiotics are given to prevent joint infection. Medications for venous thromboembolism prophylaxis are also recommended. Physicians should be alert for the presence of delirium, which is a common postoperative complication. Early postoperative mobilization, followed by rehabilitation, improves outcomes. Subsequent care focuses on prevention, with increased physical activity, home safety assessments, and minimizing polypharmacy. Two less common hip fractures can also occur: femoral neck stress fractures and insufficiency fractures. Femoral neck stress fractures typically occur in dancers 20 to 30 years of age, endurance athletes, and military service members, often because of training overload. Insufficiency fractures due to compromised bone strength occur without trauma in postmenopausal women. 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subjects Alcohol use
Antibiotics
Body mass index
Bone Density
Bone diseases
Caffeine
Clinical medicine
Clinical trials
Diagnostic tests
Diuretics
Female
Femoral Neck Fractures - complications
Femoral Neck Fractures - surgery
Fractures
Fractures, Stress - complications
Hemoglobin
Hip Fractures - complications
Hip Fractures - diagnosis
Hip Fractures - therapy
Humans
Joint surgery
Medical diagnosis
Metabolism
Mortality
Orthopedics
Osteoporosis
Pain
Patients
Radiography
Risk factors
Socioeconomic factors
Steroids
Surgeons
Vitamin D
title Hip Fractures: Diagnosis and Management
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