A hip fracture is a break in the upper femur near the hip joint, most often in older adults after a fall from standing height. Early surgery and early walking lower the risk of complications and death.
Key symptoms
- Groin or hip pain after a fall
- Unable to stand or bear weight
- Pain when the leg is moved
- Sometimes only vague knee or thigh pain
What you find on exam
- Leg shortened and turned outward
- Pain when the leg is rolled
- Distal pulses and sensation
- Cause of the fall, other injuries and signs of delirium
Tests
- Hip and pelvis X-rays
- MRI or CT if X-rays are normal but suspicion stays high
- Preoperative labs, ECG and blood type
Treatment basics
- Pain control, including a fascia iliaca nerve block
- Surgery within 24 to 48 hours: fixation or hip replacement
- Clot prevention with low molecular weight heparin such as enoxaparin
- Early walking, rehab and osteoporosis treatment
- Fall and delirium prevention
Red flags
- Delirium or confusion
- Low blood pressure or major blood loss
- Signs of a blood clot: leg swelling or sudden shortness of breath
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; CDC STEADI (falls in older adults). Written by Making Synapses. Making Synapses is not affiliated with these organizations.