II. Epidemiology

  1. Uncommon Hip Fracture (accounts for only 3% of Hip Fractures)

III. Pathophysiology

  1. Images
    1. hipFractureRegions.jpg
  2. Extracapsular Hip Fracture
    1. Contrast with Femoral Neck Fracture
  3. Mechanism of injury: Direct blunt Trauma
    1. High energy injury
    2. Gun shot wound
    3. Falls in the elderly
    4. Pathologic Fracture (Paget's Disease, Metastases)

IV. Diagnosis

  1. See Hip Fracture
  2. First 5 cm of femoral shaft below lesser trochanter
    1. Above Femoral Shaft Fracture
    2. Below Intertrochanteric Fracture
  3. Descriptive Classification
    1. Proximal or distal location
    2. Transverse or oblique angle
    3. Comminuted (common)

V. Management

  1. Evaluate for associated injuries (see pitfalls below)
  2. Closely manage fluid status
    1. Initial Resuscitation with isotonic crystalloid
    2. Type and Cross for 2 Units pRBC
    3. Continually reassess hemodynamic status
  3. Intramedullary rod and nail (stabilizes femoral head and shaft)
    1. Perform in first 48 hours

VI. Pitfalls

  1. Significant blood loss
    1. From Hip Fracture or due to associated injuries
  2. Coexisting Fractures are common (up to 50%)
    1. Pelvic Fracture
    2. Vertebral Fracture
  3. High energy Trauma is associated with other injuries
    1. Thoracic Injury
    2. Abdominal Injury

VII. Complications

  1. Fat embolism
  2. Immobility associated morbidity

VIII. Prognosis

  1. Mortality up to 20% due to comorbid injuries

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