Hip fracture
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7292.968 (Published 21 April 2001) Cite this as: BMJ 2001;322:968
- William John Gillespie (bill.gillespie@stonebow.otago.ac.nz), professor
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Background
Definition Hip fracture is a fracture of the femur above a point 5 cm below the distal part of the lesser trochanter.1 Intracapsular fractures occur proximal to the point at which the hip joint capsule attaches to the femur. Undisplaced fractures include impacted or adduction fractures. Displaced intracapsular fractures may be associated with disruption of the blood supply to the head of the femur. Numerous subdivisions and classification methods exist for these fractures. In the most distal part of the proximal femoral segment (below the lesser trochanter), the term subtrochanteric is used. Extracapsular fractures occur distal to the hip joint capsule.
Intervention
Beneficial:
Sliding hip screw device for internal fixation of extracapsular fracture
Antibiotic prophylaxis before surgery
Mattress on operating tables to prevent pressure sores
Likely to be beneficial:
Regional anaesthesia for surgery
Arthroplasty for displaced intracapsular fracture
Postoperative prophylaxis with heparin to reduce venous thromboembolism
Postoperative prophylaxis with antiplatelet agents to reduce venous thromboembolism
Postoperative prophylactic cyclical compression of the foot or calf to reduce venous thromboembolism
Nutritional supplementation after fracture
Geriatric hip fracture programmes in acute orthopaedic units
Trade off between benefits and harms:
Early supported discharge programmes
Unknown effectiveness:
Arthroplasty for extracapsular hip fracture
Nerve blocks for pain control
Use of graduated elastic compression to prevent venous thromboembolism
Specialised orthopaedic rehabilitation units for elderly people
Systematic home based rehabilitation
Unlikely to be beneficial:
Conservation (non-surgical) treatment of extracapsular fractures
Preoperative bed traction to the injured limb
Likely to be ineffective or harmful:
Intramedullary fixation with cephalocondylic nail for extracapsular fracture (less effective or more harmful than sliding hip screw)
Intramedullary fixation with condylocephalic nail for extracapsular fracture
Incidence/prevalence Hip fractures may occur at any age but are most common in elderly people. In industrialised societies, the lifetime risk of hip fracture is about 18% in women and …
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