Hip fractures are a serious health problem common among elderly
men and women who fall in their own homes. In 2003 there were
about 345,000 hospitalizations for hip fractures (Source:
National Center for Health Statistics; Centers for Disease
Control and Prevention; 2003 National Hospital Discharge
Survey.) Only one in four patients recover completely.
Hip fractures are more common in older
people because of osteoporosis and because older people are more
likely to fall. One in three women and one in six men who reach
age 90 will fracture a hip during his or her lifetime.
The upper end of the femur has
large bony bumps called trochanters where powerful muscles
attach. Then there is a short neck and finally a spherical head
that forms the outer half of the hip joint. Most hip fractures
occur just below the spherical head and are called femoral neck
or subcapital hip fractures. If the fractures is through the
trochanters it is called a intertrochanteric hip fracture.
Femoral neck hip fractures are
particularly problematic because the fracture often disrupts the
blood supply to the femoral head, which forms the hip joint.
Without a good blood supply, the bone cannot heal and eventually
collapses and dies.
Femoral neck fractures involve the narrow neck
between the round head of the femur and the shaft. This fracture
often disrupts the blood supply to the head of the femur.
The femoral neck fractures are classified as
Garden type fractures:
-
Type 1 is non-displaced.
-
Type 2 has impaction of the fracture but no
displacement.
-
Type 3 is displaced (often rotated and
angulated) but still has some contact between the two
fragments.
-
Type 4 is completely displaced and there is
no contact between the fracture fragments.
The blood supply of the femoral head is much
more likely to be disrupted in Garden types 3 or 4 fractures.
|
Garden Type 2 Fracture |
Garden Type 3 Fracture |
Surgeons can treat these types of fracture by
replacing the fractured bone with a total hip replacement. If
possible, the surgeon tries to reduce the fracture, manipulate
the fragments back into a good position and fix them in place
with three metal screws.
A serious but common complication of a fractured
femoral neck is
avascular necrosis. The vasculature to the femoral head is
easily disturbed during fractures or from swelling inside the
joint capsule. This can lead to strangulation of the blood
supply to the femoral head and death of the bone and cartilage.
Additional References about Hip Fractures:
EmedX
Family Medicine Resource
About Hip Fractures
