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A 60-year-old woman comes to the emergency room for hip pain. She felt a pop in her hip accompanied by the immediate onset of pain that prohibited her from walking. She had fallen 2 days prior. Figure 107-1 shows a transcervical left femoral neck fracture with varus angulation and superior offset of the distal fracture fragment. She was evaluated by an orthopedic surgeon and underwent surgery the next day in a hospital that provides co-management by a geriatrician (Figure 107-2). After many months of rehabilitation, she was able to walk again.
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Approximately 300,000 hip fractures per year occur in the United States.1
More common in the United States (554 per 100,000 women, 197 per 100,000 men) and North Europe; intermediate prevalence in Asian countries; lowest prevalence in Latin America and Africa.2
70% to 80% of hip fractures occur in women.1
Average age is 77 years in women; risk increases with age.3
Half of patients with a hip fracture have osteoporosis.4
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ETIOLOGY AND PATHOPHYSIOLOGY
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Between the age of 60 and 80 years:
Women: lower body weight, prior osteoporotic fracture, hip fracture in first-degree relatives and lower plasma 25-hydroxyvitamin D (25OHD).5
Men: prior osteoporotic fracture and lower plasma 25OHD.5
Over age 80 years, in both women and men, falls are the most important risk factor.5
Short- and long-term use of a proton pump inhibitor is associated with an increased risk of fracture [RR = 1.26, 95% confidence intervals 1.16–1.36].6
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CLINICAL FEATURES: HISTORY AND PHYSICAL
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History
Risk factors including older age, female gender
Recent fall
Pain in the groin, which may be referred to the thigh or knee7
Inability to walk is common; rarely patients are ambulating with an assistive device and experience increased pain with walking7
Physical examination
Abducted and externally rotated hip; limp or refusal to walk7
Pain elicited with internal and external rotation while patient lies supine7
Groin pain elicited with an axial load7
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