Def. Fracture of the proximal femur

Prognosis

• 50% cannot return to pre-existing indepedent ambulation
• 25% all-cause mortality in 1 yr
• 20% permanent admission to LTC

Prevention

• OP - Osteoporosis Prevention (Diet)
  • Vitamin D Supplement (800-2000 IU/day)
  • Ca Supplement (1200 mg/day)
  • BP - Biphosphonate (Alendronate 70 mg/wk, Risedronate 35 mg/wk)
• Prevention
  • remove tripping hazards at home, occupational safety, etc.
  • Assistive devices such as walkers

Surgical Treatment

<aside> 💡 Hip Fracture is an indication of OPEN Surgery. Both extra- and intra-capsular fracture demands open surgery because:

1. Early mobilization → the immobilization time for closed reduction is unacceptable (consequences: DVT/PE, Pressure ulcer , Pneumonia ). ** MOST Important

2. Better Nursing and Pain control

3. High Mortality Rate without operation (reduced by operation within 48 hrs) </aside>

4. OPIF - Open Reduction Internal Fixation → Risk of AVN - Avascular Necrosis

5. Hip Replacement (arthroplasty) → Definitive, no risk of AVN

   1. Hemianthroplasty
   2. Total Hip Anthroplasty

Surgery Risk of complication (5)

• AVN - Avascular Necrosis : goes up with higher displacement
• Nonunion (fracture doesn’t heal) -> esp. when displaced, 5-10% chance
• Infection (bleeding)
• Decreased function
• Death