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Review
. 2011:6:1-7.
doi: 10.2147/CIA.S10204. Epub 2010 Dec 20.

Fractures in the elderly: when is hip replacement a necessity?

Prasad Antapur  1 , Nizar Mahomed, Rajiv Gandhi
Affiliations
Review

Fractures in the elderly: when is hip replacement a necessity?

Prasad Antapur et al. Clin Interv Aging. 2011.

Abstract

As the world's population ages, hip fractures pose a significant health care problem. Hip fractures in the elderly are associated with impaired mobility, and increased morbidity and mortality. Associated conditions, such as osteoporosis, medical comorbidity, and dementia, pose a significant concern and determine optimal treatment. One-year mortality rates currently range from 14% to 36%, and care for these patients represents a major global economic burden. The incidence of hip fractures is bimodal in its distribution. Young adult hip fractures are the result of high energy trauma, and the larger peak seen in the elderly population is secondary to low-energy injuries. The predilection for the site of fracture at the neck of femur falls into two major subgroups. Pertrochanteric fractures occur when the injury is extracapsular and the blood supply to the head of femur is unaffected. The management of this group involves internal fixation through a sliding hip screw device or intramedullary fixation device, both of which have good results. The other group of patients who sustain an intracapsular fracture at the femoral neck are at increased risk of nonunion and osteonecrosis. Recent papers in the literature have shown better functional outcomes with a primary hip replacement over other treatment modalities. This article reviews the current literature and indications for a primary total hip replacement in these patients.

Keywords: elderly; hip fractures; hip replacement.

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Figures

Figure 1
Figure 1
Algorithm for management of displaced fractures in the elderly. Abbreviation: ORIF, open reduction and internal fixation.
Figure 2
Figure 2
Displaced fracture neck of femur in an independently mobile 78 year old.
Figure 3
Figure 3
Immediate postoperative radiographs post total hip arthroplasty.
See this image and copyright information in PMC

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