Injuries to the hip and femur are common, occurring most often
in the elderly population. There are more than 300,000 hospitalizations
annually in the U.S. for hip fracture; it is estimated that incidence
may double by the year 2040 due to the aging population.1,2 Age,
race, and gender are important factors in hip injuries, with incidence
doubling for each decade past the age of 50 years old. The incidence
is approximately two to three times higher in women than in men.
Morbidity and mortality is substantial, with the majority being
due to prolonged immobilization, deep venous thrombosis, and pulmonary embolus.
It is estimated that 20% of seniors who sustain hip fractures
die within 1 year; the greatest risk is in the first 6 months after
the injury. Nearly another 20% require nursing home care,
costing an estimated $2.8 billion per year.1,3–6 Though
some recent data suggest an overall decline in incidence and mortality
in the U.S., hip and femur injuries remain a major source of morbidity
and mortality world-wide.6 Advanced age and comorbidities
are important risk factors for increased mortality.7,8
The hip is a ball-and-socket joint formed by the femoral head
and the acetabulum. The fibrous capsule that surrounds the joint
on all sides is exceedingly strong. It attaches around the acetabulum
proximally and runs to the intertrochanteric line distally on the
anterior surface. Posteriorly, it falls short of the intertrochanteric
crest and inserts on the neck of the femur. It is weakest posteriorly.
The femoral head is joined to the shaft by the obliquely angled
femoral neck, with the intersection at the intertrochanteric line
formed by the greater and lesser trochanters. Blood is supplied
to the femoral head mainly from the medial and lateral femoral circumflex
arteries that form an extracapsular ring and course inside the capsule
at its insertion to the proximal femur. Less important blood supply
includes branches of the obturator and gluteal arteries, with a
small contribution from the foveal artery at the ligamentum teres.
Hip fractures are classified as femoral head and neck (intracapsular),
trochanteric, intertrochanteric, and subtrochanteric (extracapsular) (Figures 270-1 and 270-2 and Table 270-1). The prognosis for successful
union and restoration of normal function varies considerably with
the fracture type. The vast majority of fractures occur in older
patients with osteoporosis or other bony pathology secondary to
systemic disease. Younger patients are more likely to have femoral
shaft fractures or hip dislocation secondary to high-energy trauma.
Fracture of proximal femur. Fractures of the proximal femur
are traditionally classified as intracapsular and extracapsular.
(Reproduced with permission from Greenspan A: Orthopedic
Radiology. Philadelphia, JB Lippincott, 1988, p. 517.)
Hip and capsule.
Log In to View More
If you don't have a subscription, please view our individual subscription options
below to find out how you can gain access to this content.
Want access to your institution's subscription?
Sign in to your MyAccess Account while you are actively authenticated on this website
via your institution (you will be able to tell by looking in the top right corner
of any page – if you see your institution’s name, you are authenticated). You will
then be able to access your institute’s content/subscription for 90 days from any
location, after which you must repeat this process for continued access.
If your institution subscribes to this resource, and you don't have a MyAccess account,
please contact your library's reference desk for information on how to gain access
to this resource from off-campus.
AccessMedicine Full Site: One-Year Subscription
Connect to the full suite of AccessMedicine content and resources including more than 250 examination and procedural videos, patient safety modules, an extensive drug database, Q&A, Case Files, and more.
Pay Per View: Timed Access to all of AccessMedicine
48 Hour Subscription
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.