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INTRODUCTION

THIS CHAPTER WILL ADDRESS TOPICS PERTINENT TO the rehabilitation of patients with hip fractures as well as their preventative measures. There will be an emphasis on prevention of falls, the most common etiology of hip fractures.

Definition/Anatomy

The acetabulofemoral joint (aka the “hip joint”) is a ball and socket synovial joint connecting the femoral head and the acetabular part of the pelvis.1 Hip fracture commonly refers to the fracture of the upper quarter of the femur (aka the femoral head; Fig. 84–1).

Figure 84–1

Anatomy of the hip joint. (Reproduced with permission from Chapter 35. Gluteal Region and Hip. In: Morton DA, Foreman K, Albertine KH, eds. The Big Picture: Gross Anatomy, New York, NY: McGraw-Hill; 2011.)

Hip fractures can be categorized by the anatomical location and the stability of the fracture (either stable or unstable based on likelihood of postoperative compromise). The hip joint capsule consists of the femoral head, as well as the fibrous tissue and the cartilage that surrounds it. Fractures in the hip joint are referred to as intra-capsular and fractures outside the joint are called extra-capsular. Vascular supply to the intra-capsular structures is primarily via the often minute acetabular branch of the obturator artery from the acetabular side and the superior and inferior medial circumflex arteries supplying primarily the femoral neck side. Arterial flow to these structures can be limited when fractures of the femoral neck also compromise the medial circumflex arteries and can contribute to the higher rate of avascular necrosis and impaired bone healing. Three most common types of hip fractures are femoral neck fracture (intra-capsular, most common), intra-trochanteric (between the greater and lesser trochanters, second most common, extra-capsular) and subtrochanteric (from the lesser trochanter to ∼2.5 inches below it, extra-capsular).1,2 Stability of the femoral neck fractures can be easily assessed using the Simplified Garden Criteria classifying displaced fractures as unstable and non-displaced as stable.3 Intra-trochanteric fractures are commonly described as stable or unstable using the Jenson-Evans Classification based on the number of bone fragments4,5 (Fig. 84–2).

Figure 84–2

Characteristics of different types of hip fractures. (Reproduced with permission from Immobility. In: Kane RL, Ouslander JG, Resnick B, Malone ML, eds. Essentials of Clinical Geriatrics, 8e New York, NY: McGraw-Hill; 2018.)

Epidemiology/Risk Factors

Elderly post-menopausal osteoporotic thin white females are predisposed to develop hip fractures. A common mechanism of injury is a low energy trauma from an indoor fall onto side. Important non-modifiable risk factors for hip fractures include advanced age and female gender. Data shows that incidence of hip fracture increases from 22.5 per 100,000 at age 50, to 630 per 100,000 for men ...

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