Medical management in the acute hip fracture patient: a comprehensive review for the internist

Abstract

Each year, more than 250,000 Americans will suffer a broken hip from a fall from no more than standing height. The National Osteoporosis Foundation estimates that more than 500,000 acute hip fractures will occur annually by the year 2040. The costs associated with this healthcare phenomenon are staggering and will continue to increase with an aging population.Hospitalists routinely comanage orthopedic patients as either consultants or as primary physicians in the hospital setting. A unique set of problems exists in this population. Among them are perioperative cardiac risk, perioperative anemia from acute blood loss, venous thromboembolism prophylaxis, and problems with the timing of surgery. It is imperative that hospitalists understand the orthopedic surgeon's point of view in managing these particular problems and become familiar with the evidence supporting or refuting treatment modalities related to these subject areas. In addition, an understanding of the anatomy and surgical options and complications related to each type of fracture allows the hospitalist to become familiar with postoperative rehabilitation needs. It cannot be overstated that addressing hip fracture prevention must be a part of every patient's perioperative care because the incidence of a repeat fracture is significant. Morbidity related to the fracture and comorbidities also need close examination.This article aims to provide a solid understanding of the issues associated with the acute hip fracture population to enhance practice and allow for the best outcome for patients.

Keywords: Femoral neck fracture; hip fracture.

Figure 1.

Anatomic regions of the hip where fractures are likely to occur. (Reprinted with permission from Zuckerman JD. N Engl J Med. 1996 Jun 6;334(23):1519-1525.⁸)

Figure 2.

Garden classification: Type 1—undisplaced and incomplete fracture; Type 2—undisplaced complete fracture; Type 3—complete fracture but incompletely displaced; Type 4—complete fracture and completely displaced. (Reprinted with permission from Malanga GA, Jasey NN Jr., Solomon J. Femoral Neck Fracture. Medscape. Jan 28, 2009. http://emedicine.medscape.com/article/86659-overview. Accessed February 12, 2011.¹¹)