Overview
Proximal femur fractures, including femoral neck fractures (FNF) and pertrochanteric fractures (PF), are common in elderly patients, often associated with osteoporosis and poor bone quality.Diagnosis
Risk Factors: Age, low bone mineral density (BMD), particularly lower in the intertrochanteric region for PF and femoral neck region for FNF 1.
Laboratory Tests: Evaluate vitamin D levels and parathyroid hormone (PTH) levels; low vitamin D with high PTH in PF, low vitamin D with normal PTH in FNF 1.
Imaging: X-rays are essential for classification (FNF vs PF) and assessing fracture pattern and displacement 2.Management
Surgical Intervention: Open reduction and internal fixation (ORIF) with implants like dynamic hip screws or intramedullary nails; cement augmentation may improve stability in geriatric intertrochanteric fractures 2.
Pain Management: Consider prehospital fascia iliaca compartment (FIC) block for effective analgesia in elderly patients, performed by trained EMS nurses 3.
Post-Fracture Care: Early mobilization and rehabilitation to prevent complications such as deep vein thrombosis and pneumonia 4.Special Populations
Elderly: Increased risk due to osteoporosis, comorbidities, and poorer bone quality; orthogeriatric units can reduce hospital stay and improve discharge outcomes 4.
Comorbidities: Hip osteoarthritis is less severe in FNF compared to PF, potentially influencing surgical approach and recovery 1.Key Recommendations
Assess BMD and Vitamin D Levels: Evaluate bone mineral density and vitamin D status to differentiate between femoral neck and pertrochanteric fractures (Evidence: Moderate 1).
Consider Cement Augmentation: For geriatric patients with unstable intertrochanteric fractures, cement augmentation can enhance implant stability (Evidence: Moderate 2).
Utilize Prehospital FIC Block: Implement prehospital fascia iliaca compartment block by trained EMS nurses for effective pain management in elderly patients with proximal femur fractures (Evidence: Weak 3).
Early Discharge Planning: Utilize orthogeriatric units to optimize discharge planning and reduce hospital stay in elderly patients with proximal femur fractures (Evidence: Moderate 4).References
1 Matrangolo MR, Smimmo A, Vitiello R, De Fazio A, El Motassime A, Noia G et al.. Predictor of hip fracture type: a systematic review. Acta bio-medica : Atenei Parmensis 2023. link
2 Goodnough LH, Wadhwa H, Tigchelaar SS, DeBaun MR, Chen MJ, Graves ML et al.. Indications for cement augmentation in fixation of geriatric intertrochanteric femur fractures: a systematic review of evidence. Archives of orthopaedic and trauma surgery 2022. link
3 Dochez E, van Geffen GJ, Bruhn J, Hoogerwerf N, van de Pas H, Scheffer G. Prehospital administered fascia iliaca compartment block by emergency medical service nurses, a feasibility study. Scandinavian journal of trauma, resuscitation and emergency medicine 2014. link
4 Boyd RV, Hawthorne J, Wallace WA, Worlock PH, Compton EH. The Nottingham orthogeriatric unit after 1000 admissions. Injury 1983. link90013-x)