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Over 350,000 hip fractures occur annually, costing nearly $6 billion. Hip fractures are a life-changing injury. Forty percent of patients fail to regain preinjury ambulation status at 6 months and fail to return to independent living at 1 year, and nearly 25% of those suffering from this injury die within 12 months. Morbidity and mortality result from prolonged immobilization. Compromised preinjury ambulation status and dependent living are predictors of poor functional outcome and long-term mortality.1,2

Hip dislocations are associated with devastating complications. Disruption of vascular supply can result in avascular necrosis and is estimated to occur in up to 25% of hip dislocations. This life-changing complication nearly always mandates total hip arthroplasty (THA).3

Femur fractures are most often associated with trauma and occur across a much broader demographic. These high-energy fractures can result in life-threatening blood loss.4


Hip fractures are defined by their anatomic location (Figures 273-1 and 273-2 and Table 273-1) and classified as intracapsular (femoral head and neck) or extracapsular (trochanteric, intertrochanteric, and subtrochanteric). Treatment will vary considerably with fracture type (Table 273-2).

FIGURE 273-1.

Fractures of the proximal femur are traditionally classified as intracapsular and extracapsular.

FIGURE 273-2.

Hip and joint capsule.

TABLE 273-1Proximal Femur Fractures: Demographics and Clinical Features

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