In some instances, however, patients with hip fracture may complain only of vague pain in their buttocks, knees, thighs, groin, or back. They are often unable to walk, and they may exhibit shortening and external rotation of the affected limb. A lucency, representing the fracture, runs between the two trochanters (white arrows).Patients with hip fracture typically present to the emergency department or their physician's office after a fall. There is varus deformityįor a larger photo of the same image without arrows, click on this link (white arrow) and lesser trochanter (red arrow). There are separate fragments of the greater trochanter O Many intertrochanteric fracture are associated with a varus deformityĬomminuted intertrochanteric fracture. O Intertrochanteric fractures associated with a separate fragment of lesser trochanter may also include a portion of the posterior cortex of femoral neck and are considered unstable O Comminuted fractures may also manifest separate fragments of either or both of the lesser and greater trochanters O Most common of the extracapsular hip fractures O May be difficult to differentiate a basicervical fracture from a non-displaced and non-comminuted intertrochanteric fracture O Frequently associated with varus deformity O Usually easy to see on views of the hip obtained in internal rotation On the lateral view, the same step-off can be seen (red arrow) as well as the impaction (white arrow). On the frontal view, there is a step-off in the cortex superiorly (red arrow) while there is abnormal overlapping of the femoral head and neck (white arrows) due to impaction. § May require additional imaging such as MRI for confirmation of fracture O Pitfall: a rim of osteophytes may form around the femoral head and project over the neck mimicking the sclerotic line of a subcapital fracture O There may be a discontinuity in the normal smooth curve of the superior aspect of the femoral neck as it joins the head O White line of increased density of impacted bone may be seen at base of femoral head O Most common intracapsular fracture of the hip O The more displaced the fragments are, the higher the rate of complications Intracapsular fractures have a higher incidence of nonunion and avascular necrosis of the femoral head (up to 35%) than extracapsular fractures.O Intertrochanteric and subtrochanteric are extracapsular O Subcapital, transcervical and basicervical are intracapsular Hip fractures can be classified as to their geographic position as: subcapital, transcervical, basicervical, intertrochanteric and subtrochanteric.O The femoral neck will be seen in profile when the leg is held in internal rotation O When further imaging is required, MRI or nuclear medicine scans are used most often utilized O Conventional radiography is the study of first choice Most hip fractures occur in Caucasian women.In younger individuals, hip fractures are often the result of high velocity, high impact trauma.O Most hip fractures in the elderly (90%) occur as a result of a fall, frequently a minor fall such as from the standing position Conditions that predispose to hip fractures include aging, osteoporosis and osteomalacia.Hip fractures are associated with a substantial mortality, as many as 15-20% dying within one year of the fracture.
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