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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.

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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

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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.

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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.

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Figure 270-1.
Graphic Jump Location

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.)

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Figure 270-2.
Graphic Jump Location

Hip and capsule.

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Table Graphic Jump Location
Table 270-1 Proximal Femur Fractures: ...

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