injuries poisoning
Hip Fractures
Key Points
Hip (particularly subcapital and intertrochanteric) fractures are common among older patients with osteoporosis. Osteonecrosis of the femoral head, fracture nonunion, and osteoarthritis are common complications. If circumstances suggest a hip fracture and patients cannot flex the entire lower limb against resistance with the knee extended, suspect an impacted fracture, even if patients have only mild pain and can walk. For all patients with unexplained hip or knee pain and difficulty walking due to pain, rotate their hip with their knee flexed; if this maneuver aggravates the pain, hip fracture is possible. If a fracture is suspected based on clinical findings but is not seen on x-rays, do MRI. Treat most fractures surgically (ORIF or hip arthroplasty) so that patients can walk as soon as possible. Consider using femoral nerve blocks and fascia iliaca compartment blocks instead of opioids for short-term pain control, particularly in older patients with isolated hip fractures. 