Hip Fracture

Hip fractures occur most commonly in the femoral neck or intertrochanteric region. In an older adult, a fall from standing height may be enough because osteoporosis has reduced bone mineral density and weakened the proximal femur. Corticosteroid exposure, vitamin D deficiency, impaired balance, cognitive impairment, and medications that cause sedation or orthostatic hypotension increase the likelihood of both fracture and recurrent falls. A displaced femoral neck fracture is intracapsular. Displacement can tear the retinacular vessels supplying the femoral head, increasing the risk of avascular necrosis and nonunion. That blood-supply problem is why arthroplasty is often considered for displaced intracapsular injuries. Intertrochanteric fractures occur outside the joint capsule and are usually managed with internal fixation selected for the fracture pattern. The classic presentation is a painful, shortened, externally rotated leg with inability to bear weight. Do not use the absence of deformity to dismiss the injury. An impacted or nondisplaced fracture may leave the leg looking aligned, yet the patient may have severe groin pain with attempted movement or weight bearing. Repeatedly asking the patient to stand can worsen displacement and...