Fractures of the proximal femur : Sikorski J. M., Davis N. J. and Senior J. (1985) The rapid transit system for patients with fractures of proximal femur. Br. Med. J.290, 439

Abstract

ip fracture is among the most common injuries necessitating hospital admission. Fractures of the hip include fractures of the proximal femur and pelvic ring and may be classified as pathologic or nonpathologic. Regardless of the type of fracture, however, hip fractures can lead to substantial morbidity and mortality. This article discusses the epidemiology of fractures of the proximal femur and the evaluation and treatment of nonpathologic and osteoporotic pathologic proximal femoral fractures. The specific types of proximal femoral fracture discussed are intertrochanteric, femoral neck, subtrochanteric, and greater trochanteric fractures. A future article in this journal will discuss fractures of the pelvic ring, including sacral and acetabular injuries. EPIDEMIOLOGY OF PROXIMAL FEMORAL FRACTURES Between 220,000 and 250,000 proximal femoral fractures occur in the United States each year 1,2 ; 90% of these fractures occur in patients older than 50 years. 1,2 In younger patients, proximal femoral fractures are usually the result of high-energy physical trauma (eg, highspeed motor vehicle accidents) and usually occur in the absence of disease. Intertrochanteric and femoral neck fractures account for 90% of the proximal femoral fractures occurring in elderly patients. 1 Proximal femoral fractures in elderly patients are often pathologic, usually resulting from minimal-to-moderate physical trauma to areas of bone significantly affected by osteoporosis. However, pathologic fractures can occur at any age; typically, these fractures result from low-energy injuries and may be characterized by unusual fracture patterns. 3