Hip Fractures: A Practical Approach to Diagnosis and Treatment
- 86 Downloads
Purpose of Review
To summarize relevant anatomy, imaging, and treatment of hip fractures, and to synthesize a treatment-based approach for description and classification of hip fractures.
Hip fractures are predominantly seen in the elderly, where they are increasing in incidence, and can substantially reduce healthy life-years. The osseous and vascular anatomy of the proximal femur can help to understand the clinical implications of various types of hip fracture. Radiographs are the principal imaging modality for assessment of hip fracture, although there is a clear role for CT and MRI for assessment of radiographically occult fractures. There are multiple classifications of hip fractures in the orthopedic literature; however, these are not commonly used in clinical practice due to complexity, poor reported inter-observer agreement, and relatively few methods of surgical fixation.
A simplified anatomic and treatment-based approach to hip fractures can help guide image interpretation and clinical management.
KeywordsHip fractures Imaging Emergency radiology
Compliance with Ethics Guidelines
Conflict of interest
Jacob C. Mandell, Michael J. Weaver, Mitchel B. Harris, and Bharti Khurana each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Recently published papers of particular interest have been highlighted as: • Of importance •• Of major importance
- 3.Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clin Orthop Relat Res. 1990;252:163–6.Google Scholar
- 12.Ly TV, Swiontkowski MF. Intracapsular hip fractures. In: Browner BD, Jupiter JB, Krettek C, Anderson PA, editors. Skeletal trauma: basic science, management, and reconstruction. 5th ed. Philadelphia: Saunders; 2014. p. 1607.e12–81.e12.Google Scholar
- 13.• Sheehan SE, Shyu JY, Weaver MJ, Sodickson AD, Khurana B. Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics. 2015;35(5):1563–84. Provides a comprehensive overview of proximal femur fractures, including a detailed description of mechanism of action and various classification systems. Google Scholar
- 15.Koval KJ, Oh CK, Egol KA. Does a traction-internal rotation radiograph help to better evaluate fractures of the proximal femur? Bull NYU Hosp Joint Dis. 2008;66(2):102–6.Google Scholar
- 16.Khurana B, Mandell J, Rocha T, Duran-Mendicuti M, Jimale H, Rosner B, et al. An internal rotation traction radiograph improves proximal femoral fracture classification accuracy and agreement. Am J Roentgenol. 2018, in Press.Google Scholar
- 34.• Kellock TT, Nicolaou S, Kim SSY, Al-Busaidi S, Louis LJ, O’Connell TW, et al. Detection of bone marrow edema in nondisplaced hip fractures: utility of a virtual noncalcium dual-energy CT application. Radiology. 2017;284(3):798–805. Describes the use of dual-energy CT in detecting bone marrow edema in the setting of nondisplaced hip fractures. Google Scholar
- 41.Mandell JC, Marshall RA, Banffy MB, Khurana B, Weaver MJ. Arthroscopy after traumatic hip dislocation: a systematic review of intra-articular findings, correlation with magnetic resonance imaging and computed tomography, treatments, and outcomes. Arthroscopy. 2017;34:917–27.CrossRefPubMedGoogle Scholar
- 55.• Watson ST, Schaller TM, Tanner SL, Adams JD, Jeray KJ. Outcomes of low-energy basicervical proximal femoral fractures treated with cephalomedullary fixation. J Bone Joint Surg Am. 2016;98(13):1097–102. Basicervical fractures are rare. This report emphasizes the importance of accurately identifying these fractures. Google Scholar
- 57.Leslie MP, Baumgaertner MR. Intertrochanteric hip fractures. In: Skeletal trauma: basic science, management, and reconstruction, vol 2, 5th ed. Elsevier Inc., Amsterdam; 2003. pp. 1683.e3–720.e3.Google Scholar
- 68.•• Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American society for bone and mineral research. J Bone Miner Res. 2014;29(1):1–23. This task force report describes the imaging findings critical to identify atypical femoral fractures. Google Scholar