BY DR. TASADUQ HUSSAIN MIR
Hip fracture is the 10th most common cause of disability globally and there is a rising trend especially in the Indian subcontinent. In India incidence of hip fracture is 105 and 159 per 100,000 among men and women, respectively with 1-year mortality of 42%.
Presentation: Patients with hip fractures usually present with anterior groin pain, inability to bear weight, or have a shortened, externally rotated leg that is away from midline.
Risk factors: These can be divided into nonmodifiable risk factors and modifiable risk factors. Nonmodifiable risk factors include lower socioeconomic status, older age, female sex, prior fracture, metabolic bone disease, and cancer of the bones.
Modifiable risk factors include low body mass index (low weight), osteoporosis (weakening of the bones), increased fall risk, and medications that increase fall risk or decrease bone mineral density.
Polypharmacy (using 5 or more medications) is another modifiable risk factor and should always be taken into consideration when seeing an elderly patient in a clinic for other medical conditions. This is an opportunity for physicians to decrease risk of unnecessary falls.
Diagnosis: Simplest, quickest and easiest way to diagnose hip fracture is based on clinical presentation and an x-ray of the hip. If suspicion for hip fracture is high but x-ray does not show any fracture then consider MRI.
Management: Key to management of hip fractures is to make sure that patient has a proper referral to Orthopedic surgeon within 24 to 48 hours of the injury. Operative management within 24 to 48 hours of the fracture optimizes outcomes and also helps with prevention of long-term complications. Most fractures are usually managed by surgery, with the approach based on fracture type and location but nonsurgical management can be considered for patients who are not good surgical candidates.
Complications: There are some immediate and long-term complications. Delirium after hip surgery is very common and should be taken into consideration when a patient has altered mental status after surgery. Infection and blood clot formation is another complication after hip surgery. Patients who are going for hip surgery need antibiotics within 1 to 2 hours before surgery and are continued for 24 hours after the surgery. To prevent blood clots American Academy of orthopedic surgeons, recommends Aspirin as an effective, safe and inexpensive alternative to prevent blood clots after hip surgery. According to recent studies low-dose Aspirin 81 mg daily has been found to be as effective as high-dose aspirin for prevention of blood clots after total hip arthroplasty.
Role of physical therapy: Physical therapy has a significant role to play after surgery for adequate recovery and functionality.
Prevention: Physical activity is effective for primary and secondary prevention of hip fractures and the US Preventive Services Task Force (USPSTF) recommends exercise to prevent falls in adults older than 65. USPSTF also recommends bone scan in women older than 65 as a screening test for osteoporosis. Although a lot of patients take vitamin D supplements, a 2018 USPSTF review concluded that vitamin D supplementation has no benefit in fall prevention for older adults not known to be deficient. Individuals older than 65 years with vitamin D concentrations less than 10 ng per mL (24.96 nmol per L) are at greater risk for decreased muscle strength, low bone mineral density, and hip fractures; vitamin D repletion may be beneficial for these patients.
Dr Mir is specialises in Family Medicine and is based in Texas, USA
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK