eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Hip: Follow-up

Author: Moira Davenport, MD, Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital
Contributor Information and Disclosures

Updated: Apr 23, 2009

Follow-up

Further Inpatient Care

  • Most patients should be admitted to the hospital under the care of an orthopedic surgeon. If operative repair is planned, the patient should be cleared medically by his or her primary care physician or internist.
  • Patients with multiple medical problems can be admitted to the primary care service with orthopedic consultation.
  • Patients who have sustained multiple traumas should be admitted to the trauma service or general/trauma surgeon.

Further Outpatient Care

  • Few patients are eligible for discharge; those who are sent home usually require prolonged bed rest.
  • Consultation with an orthopedist is imperative because of the variety of treatment options and preferences.

Deterrence/Prevention

  • The best prevention is deterrence, specifically, avoiding the risk factors (see Causes) and undertaking fall prevention in older persons. An older patient who presents after a fall should undergo a risk assessment to prevent further falls.
  • Calcium supplementation, bisphosphonates, parathyroid hormone, and estrogen replacement therapy may decrease the risk of hip fractures in individuals with osteoporosis.
  • A meta-analysis was performed to evaluate the efficacy of oral supplemental vitamin D in preventing nonvertebral and hip fractures among older individuals (65 y or older). The meta-analysis included 12 double-blind, randomized, controlled trials (RCTs) for nonvertebral fractures (n = 42,279) and 8 RCTs for hip fractures (n = 40,886) and compared oral vitamin D (with or without calcium) with either calcium alone or placebo. The results showed that nonvertebral fracture prevention with vitamin D is dose dependent, and a higher dose reduced fractures by at least 20% for individuals aged 65 years or older.4

Complications

Prognosis

  • Hip fracture outcomes vary considerably depending upon the patient's age, comorbidities, fracture type, and numerous other factors.
  • In general, young patients almost always regain the ability to ambulate, yet depending on fracture type, they may not return to their previous level of activity.
  • Many older patients do not regain the ability to ambulate or are able to do so only with assistance. This profoundly affects their ability to live independently.
  • Almost 20% of patients never regain the ability to ambulate, and a similar percentage are unable to ambulate outside their homes.
  • Only 50-65% regain their premorbid ambulatory status.

Patient Education

  • Prevention of hip fracture is vastly superior to current treatment modalities. Gear patient education toward identification of avoidable risk factors in the patient's life.
  • In young persons, stress avoidance of tobacco and alcohol abuse and safe, responsible use of motorized vehicles.
  • Counsel older persons on ways to make their home environment safe from falls. Encourage them to consult with their primary physician regarding medications or supplements for the prevention and treatment of osteoporosis.
  • For excellent patient education resources, visit eMedicine's Foot, Ankle, Knee, and Hip Center and Breaks, Fractures, and Dislocations Center.

Miscellaneous

Medicolegal Pitfalls

  • Failure to prevent patient with a stress or incomplete femoral neck fracture from ambulating, thus creating a complete or displaced fracture
  • Failure to consider diagnosis of stress fracture of the femoral neck in a young patient with chronic hip or knee pain
  • Failure to consider diagnosis of incomplete femoral neck fracture in an older patient with hip pain and nondiagnostic standard radiograph views.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Gigi R Madore, MD, and Geoff Winkley, MD, to the development and writing of this article.



More on Fracture, Hip

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Multimedia: Fracture, Hip
References
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References

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Further Reading

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Keywords

hip fracture, fracture of the hip, femoral head fractures, femoral neck fractures, intertrochanteric fractures, trochanteric fractures, subtrochanteric fractures, hip joint, iliofemoral ligament, pubofemoral ligament, ischiofemoral ligament, avascular necrosis, intracapsular fracture, extracapsular fracture, anterior dislocation, posterior dislocation, single fragment fracture, comminuted fracture, stress fracture, incomplete fracture, impacted fracture, partially displaced fracture, completely displaced fracture, single fracture lines, multiple fracture lines, nondisplaced fracture

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Contributor Information and Disclosures

Author

Moira Davenport, MD, Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital
Moira Davenport, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital, Manhattan
Eric Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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