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Hip Fracture

As the population ages, the prevalence of hip fractures is increasing at an alarming rate. These fractures can be classified as femoral neck fractures, intertrochanteric fractures and subtrochanteric fractures. The first two are by far the most common and typically occur from a fall. As we age, our bone mass declines resulting in bone fragility. The greater this decline, the higher the risk of fracture. Aging similarly may result in loss of muscle mass, which can cause poor balance. This heightens the risk for falls.

The most important element in the treatment of hip fractures is prevention. This involves two principle facets. The first is to address bone quality by recognizing and embracing the importance of bone health as part of generalized heath and well-being.  Given that bone mass begins to decline in the 30s and 40s, adequate calcium and Vitamin D intake is critical to limit bone loss as much as possible. Supplementation may be necessary depending on people’s diet. Those who live in northern latitudes with limited sunlight during the winter months may be prone to Vitamin D deficiency. Screening for osteoporosis through bone density testing is worth considering, particularly for post-menopausal women who are at the highest risk for this condition. If a diagnosis of osteopenia (pre-osteoporosis) or osteoporosis is made, there are different medications that can prescribed to both reduce bone loss and try to foster improvement in bone density.

The second factor is fall prevention. Regular exercise to maintain muscle mass and fitness has been shown to improve coordination and balance and lower the risk of falls.  Use of assistive devices such as a cane or walker may be necessary for those with weakness from underlying medical or physical conditions. Assessment of ones living environment for trip hazards is also important. For instance, throw rugs and electrical cords should be removed from regularly travelled routes.

Once a fracture occurs, management depends on the type of fracture but generally requires surgery for the majority of cases. The goal of hip fracture treatment is to restore mobility for patients who remains ambulatory. Surgery to stabilize the fracture during healing, or hip replacement surgery for displaced neck fractures, should be performed early for patients who are medically stable enough to tolerate an operation. Patients with medical conditions who are not in optimal health may require a few days in order to stabilize their condition and improve their readiness for surgery. If patients are not medically stable enough to tolerate surgery, nonoperative treatment may be elected. The same is true for patients who are not ambulatory at the time of their fracture.

Because these fractures most commonly occur in elderly patients with a variety of medical conditions, surgery may entail a higher risk for complications than for elective procedures. Falls resulting in fracture may be precipitated by a decline in overall health meaning that that surgery is performed under less than ideal conditions. On the other hand, studies have shown that delaying surgery may similarly heighten the risk for complications including pneumonia, congestive heart failure and blood clots. For this reason, it is often necessary to assume the higher risk and proceed with surgery at the earliest reasonable interval.