Fracture of the femur distal to the femoral head and proximal to a level 5 cm below the trochanter
- Intracapsular (within the capsule) - possible vascular compromise
- Extracapsular (outside the capsule) - 5 cm distal to lesser trochanter
- Inter-trochanteric
- Sub-trochanteric
In elderly - occurrence of falls often signs underlying ill health
Causes/Factors
- Elderly
- Those susceptible to falls
- osteoporosis/Bone metastases
- Traumatic injuries
- Low BMI
- Female
Symptoms
Signs
Get a full history
- Pain on mobilisation
- Unable to weight bear
Diagnostic Tests
Hip Exam: Look, feel, move
- Symmetry of hips, Leg length etc
- Palpate around the hip joint
- Flexion, abduction, adduction, internal and external rotation
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Blood tests
-
CXR
-
ECG
-
pevlic & hip XR
-
MRI/CT if no obvious fracture seen
Management
- Pain management - nerve block
- Early surgery
- Early mobilisation after the surgery - key to recovery
Complications/red Flags
- Thromboembolic complications
- Avascular necrosis
- Non-union/failure of fixation