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 |
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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. American Academy of Family Physicians</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36521464$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schroeder, Jeremy D</creatorcontrib><creatorcontrib>Turner, Sean P</creatorcontrib><creatorcontrib>Buck, Emily</creatorcontrib><title>Hip Fractures: Diagnosis and Management</title><title>American family physician</title><addtitle>Am Fam Physician</addtitle><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.</description><subject>Alcohol use</subject><subject>Antibiotics</subject><subject>Body mass index</subject><subject>Bone Density</subject><subject>Bone diseases</subject><subject>Caffeine</subject><subject>Clinical medicine</subject><subject>Clinical trials</subject><subject>Diagnostic tests</subject><subject>Diuretics</subject><subject>Female</subject><subject>Femoral Neck Fractures - complications</subject><subject>Femoral Neck Fractures - surgery</subject><subject>Fractures</subject><subject>Fractures, Stress - complications</subject><subject>Hemoglobin</subject><subject>Hip Fractures - complications</subject><subject>Hip Fractures - diagnosis</subject><subject>Hip Fractures - therapy</subject><subject>Humans</subject><subject>Joint surgery</subject><subject>Medical diagnosis</subject><subject>Metabolism</subject><subject>Mortality</subject><subject>Orthopedics</subject><subject>Osteoporosis</subject><subject>Pain</subject><subject>Patients</subject><subject>Radiography</subject><subject>Risk factors</subject><subject>Socioeconomic factors</subject><subject>Steroids</subject><subject>Surgeons</subject><subject>Vitamin D</subject><issn>0002-838X</issn><issn>1532-0650</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpd0E9LxDAQBfAgiruufgUpeNBLIZNJJqk3WV1XWPGi4K2kabp06T-T9uC3t-B68TQ8-PF4zAlbgkKRclL8lC055yI1aD4X7CLGwxy1guycLZCUAElyyW639ZBsgnXjFHy8Tx5ru-_6WMfEdmXyaju7963vxkt2Vtkm-qvjXbGPzdP7epvu3p5f1g-7dBCYjanizqGXWQFUGXISSDkoMqFsBaUgBWA4EFGpCVAKiVobWwiFleZopcAVu_vtHUL_Nfk45m0dnW8a2_l-irnQSimNhnCmN__ooZ9CN6-bFQmNYBBmdX1UU9H6Mh9C3drwnf-9AH8Ay5dUPg</recordid><startdate>202212</startdate><enddate>202212</enddate><creator>Schroeder, Jeremy D</creator><creator>Turner, Sean P</creator><creator>Buck, Emily</creator><general>American Academy of Family Physicians</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>202212</creationdate><title>Hip Fractures: Diagnosis and Management</title><author>Schroeder, Jeremy D ; Turner, Sean P ; Buck, Emily</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p239t-50cc3e49b16f86c4165c1b925af1d26511801666d76134243778ab253f703a423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Alcohol use</topic><topic>Antibiotics</topic><topic>Body mass index</topic><topic>Bone Density</topic><topic>Bone diseases</topic><topic>Caffeine</topic><topic>Clinical medicine</topic><topic>Clinical trials</topic><topic>Diagnostic tests</topic><topic>Diuretics</topic><topic>Female</topic><topic>Femoral Neck Fractures - complications</topic><topic>Femoral Neck Fractures - surgery</topic><topic>Fractures</topic><topic>Fractures, Stress - complications</topic><topic>Hemoglobin</topic><topic>Hip Fractures - complications</topic><topic>Hip Fractures - diagnosis</topic><topic>Hip Fractures - therapy</topic><topic>Humans</topic><topic>Joint surgery</topic><topic>Medical diagnosis</topic><topic>Metabolism</topic><topic>Mortality</topic><topic>Orthopedics</topic><topic>Osteoporosis</topic><topic>Pain</topic><topic>Patients</topic><topic>Radiography</topic><topic>Risk factors</topic><topic>Socioeconomic factors</topic><topic>Steroids</topic><topic>Surgeons</topic><topic>Vitamin D</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schroeder, Jeremy D</creatorcontrib><creatorcontrib>Turner, Sean P</creatorcontrib><creatorcontrib>Buck, Emily</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>American family physician</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schroeder, Jeremy D</au><au>Turner, Sean P</au><au>Buck, Emily</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hip Fractures: Diagnosis and Management</atitle><jtitle>American family physician</jtitle><addtitle>Am Fam Physician</addtitle><date>2022-12</date><risdate>2022</risdate><volume>106</volume><issue>6</issue><spage>675</spage><epage>683</epage><pages>675-683</pages><issn>0002-838X</issn><eissn>1532-0650</eissn><abstract>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.</abstract><cop>United States</cop><pub>American Academy of Family Physicians</pub><pmid>36521464</pmid><tpages>9</tpages></addata></record> |
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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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