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Hip fractures are common, especially in the elderly – especially those with osteoporosis – and can occur even after a simple fall to the ground. In younger patients, these fractures are the result of high-force trauma, such as in car accidents or falls from a great height.

The clinical picture after a displaced hip fracture is characteristic and includes:

• Inability to walk (often the patient cannot get up from the floor)

• Severe pain on hip joint movements

• Deformation of the limb, with the leg usually shorter and in rotation

Radiological examination

A simple pelvic-hip radiograph is usually sufficient for diagnosis. Only in cases of doubt, when there is pain but no obvious deformity or when the radiograph is normal, is a CT or MRI scan required.

Classification

Depending on the location of the fracture line, hip fractures are distinguished into:

• femoral neck fractures (subcephalic)

• intertrochanteric fractures

This distinction is important, as in subclavian fractures there is a disruption of the blood supply to the femoral head, which increases the risk of non-union and osteonecrosis.

Treatment

Subclavian fractures

Treatment is mainly surgical. Only non-displaced fractures in high-risk patients with multiple health problems can be treated conservatively with bed rest and avoidance of weight-bearing. 

In other cases, the following apply:

• Percutaneous internal osteosynthesiswith compressions screws or intramedullary nail. This is a minimally invasive technique, with small incisions and without extensive access. It is indicated mainly in younger patients, but also in older patients with non-displaced fractures.

• Hip arthroplasty. It is chosen for displaced subclavian fractures in the elderly. Internal osteosynthesis has high rates of osteonecrosis and pseudoarthrosis in these patients. Hemiarthroplasty, on the other hand, allows immediate mobilization and loading, significantly reducing the risk of complications.

• Total hip replacement.Applies in displaced subclavian fractures in patients aged 55–65 years, with a good life expectancy. The replacement of both parts (acetabulum and femoral head) offers extremely long-term results and eliminates the risk of arthritis. Modern techniques allow immediate mobilization and a rapid return to activities.

Intertrochanteric fractures

The treatment is almost always surgical and includes closed reduction and percutaneous osteosynthesis with small incisions. With the help of fluoroscopy, a special intramedullary nail is placed that ensures stability and allows immediate mobilization, even in unstable fractures. This avoids prolonged bed rest, which for elderly patients can be disastrous.