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Hip fractures in adults

Author
Katherine Walker Foster, MD
Section Editors
Patrice Eiff, MD
Chad A Asplund, MD, FACSM, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

As the elderly population grows, the number of hip fractures continues to increase. The elderly have weaker bone and are more likely to fall due to poorer balance, medication side effects, and difficulty maneuvering around environmental hazards. Clinicians in many fields are involved in caring for patients with hip fractures and should be familiar with the basic assessment and management of these injuries.

This topic review will discuss the major types of hip fractures, including basic anatomy, fracture classification, and clinical and radiographic assessment. The details of surgical treatment are beyond the scope of this review. Prevention of hip fractures, preoperative assessment and the prevention and management of common medical complications associated with hip fractures are all discussed separately. (See "Medical consultation for patients with hip fracture" and "Falls in older persons: Risk factors and patient evaluation".)

EPIDEMIOLOGY

Worldwide, the total number of hip fractures is expected to surpass 6 million by the year 2050 [1]. A total of 310,000 individuals were hospitalized with hip fractures in the United States alone in 2003, according to data from the United States Agency for Healthcare Research and Quality (AHRQ), accounting for 30 percent of all hospitalized patients [2]. Approximately one-third (101,800) of fracture patients went on to receive a hip replacement. The estimated cost for treatment is approximately 10.3 to 15.2 billion dollars per year in the United States [3-6]. From 1996 to 2010, there was a decline in the incidence of hip fractures in the Unites States with a total of 258,000 recorded for hospitalized patients. While the reasons are not entirely clear, possible explanations include the release of several bisphosphonates as well as lifestyle changes that include an increased focus on calcium and vitamin D supplementation, avoidance of smoking, moderation of alcohol use, awareness of falls, and regular weightbearing exercise [7,8].  

Hip fractures substantially increase the risk of death and major morbidity in the elderly [9,10]. These risks are especially high among nursing home residents, particularly men, patients over age 90, those with cognitive impairment and other comorbidities, individuals treated nonoperatively, and those who cannot ambulate independently [11,12]. In-hospital mortality rates range from approximately 1 to 10 percent depending upon the location and patient characteristics, but rates are typically higher in men, although this discrepancy appears to be declining in some areas [13-17]. One-year mortality rates have ranged from 12 to 37 percent [3,9,18,19], but may be declining [7]. Approximately one-half of patients are unable to regain their ability to live independently [20]. A meta-analysis of prospective studies found the relative hazard for mortality during the first three months following a hip fracture to be 5.75 (95% CI 4.94-6.67) in older women and 7.95 (95% CI 6.13-10.30) in older men [21]. Although it decreases over time, the increased risk of death likely persists, according to this review and other studies [18]. However, one large prospective case-control study found no increased risk of mortality after the first year following a hip fracture among women 70 years or older [19].

A large review of hip fractures in the United States found that femoral neck and intertrochanteric fractures occur with approximately the same frequency in patients between the ages of 65 and 99 years [22]. Intracapsular (ie, femoral neck) fractures occur about three times more often in women. The highest rates were found among white women. Intertrochanteric extracapsular fractures also occur in a 3:1 female to male ratio. Subtrochanteric fractures show a bimodal distribution (20 to 40 years and over 60 years) [23].

                                 
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Literature review current through: Sep 2017. | This topic last updated: Apr 20, 2017.
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Topic Outline

GRAPHICS