Femur fracture

Disease Description (Causes and Symptoms)

• Definition: A femur (hip) fracture is a fracture occurring around the hip joint of the thighbone (femur) (e.g., the femoral neck, trochanteric/subtrochanteric areas, etc.), an injury to an area important for walking and weight-bearing. Synonyms: hip fracture, femoral neck fracture.
• Causes and pathophysiology:
  • Occurs with high-energy trauma (such as traffic accidents) or low-energy falls in older adults (in a bathroom, on a slippery road, etc.).
  • If osteoporosis (reduced bone strength) is present, it can occur even with everyday weight-bearing or a minor fall (insufficiency fracture/stress fracture).
  • The femoral head depends on blood vessels (mainly large circumflex vessels) for its blood supply; therefore, damage to blood flow in a femoral neck fracture can result in a risk of avascular necrosis of the femoral head.
• Main symptoms:
  • Pain at the injured area (hip, groin, thigh), leg deformity (apparent shortening or rotational deformity), and swelling of the affected area
  • Inability to bear weight or walk, and severe pain when moving the hip
  • Osteoporotic nondisplaced fractures (insufficiency fractures) may not be clearly visible on initial X-rays, so an isotope study (MRI/bone scan) may be needed.

Treatment Methods

• Diagnostic tests:
  • Standard: Anteroposterior (AP) and lateral X-rays of the femur
  • If a fracture is suspected but the X-ray is negative: Further evaluation with MRI, a bone scan (isotope study), or CT
• Conservative treatment:
  • Extremely selective (in rare cases where surgery is not indicated). Pain control, bed rest, observation of bone union, etc.
• Surgical treatment (standard treatment):
  • Internal fixation: Fixation with cannulated screws, dynamic hip screws, or similar devices for impacted or minimally displaced fractures. (Impacted fractures are stable, but approximately 15% may undergo secondary displacement.)
  • Joint replacement: In older adults with severely displaced femoral neck fractures or joint destruction, hemiarthroplasty or total hip arthroplasty may be considered.
  • After surgery, the status of blood flow to the femoral head is assessed (e.g., with a bone scan) to check for avascular necrosis.
• Postoperative care and medications:
  • Early ambulation (most patients can begin walking within 7 days after surgery), and physical therapy (recovery of strength and balance)
  • Thrombosis prevention: Anticoagulants such as low-molecular-weight heparin, compression stockings, and early mobilization
  • Pain control, wound care, and pneumonia prevention (respiratory exercises)
  • Osteoporosis treatment: Calcium and vitamin D supplementation; continued osteoporosis medications such as bisphosphonates or selective estrogen receptor modulators when necessary
• Precautions:
  • Risk of surgery-related complications (infection, bleeding, device failure, and secondary displacement) and avascular necrosis of the femoral head
  • Prevention of systemic complications caused by prolonged bed rest, such as pneumonia, pressure sores, deep vein thrombosis, and pulmonary embolism, is essential

Checklist Before an Outpatient Visit (Including Example Questions)

• Items to prepare and information to confirm:
  • A list of currently prescribed medications (including anticoagulants and antiplatelet agents)
  • Past medical history (osteoporosis, diabetes, cardiovascular disease, history of anticoagulant treatment, etc.)
  • Previous test results (recent X-ray, CT, MRI, bone density test results, etc.) and surgical records (if any)
  • When symptoms began, the mechanism of injury (fall or trauma), the nature of the pain, and whether walking is possible
  • Any allergies (medications, anesthesia, etc.)
• Information that is useful to provide to the attending physician at the outpatient visit:
  • Whether there is warmth, discharge, swelling, or redness at the wound, and whether there is a fever
  • Recent weight, dietary status (nutritional status), and bowel and urinary status (related to the period of bed rest)
• Example questions (items that patients can record themselves and bring):
  • "When and how did the injury occur (the exact circumstances)?" / "When did the pain begin, and how has it changed?"

Examples of General Questions to Ask the Doctor

• What are the advantages and disadvantages of this surgical (or nonsurgical) option?
• What is the risk of complications before and after surgery (infection, thrombosis, avascular necrosis, etc.)?
• When can I begin weight-bearing after surgery, and to what extent? What will the rehabilitation plan be?
• How will osteoporosis treatment be started, and how long should it be continued?
• How will my current medications (especially thrombosis-prevention medications, diabetes medications, and anticoagulants) affect the surgery?

Examples of Disease-Specific Questions

• Is my fracture in the femoral neck (inside the joint) or in another part of the femur, and what is the optimal treatment accordingly (internal fixation vs. joint replacement)?
• What is the likelihood of avascular necrosis of the femoral head after surgery, and when will tests (bone scan or MRI) be performed to detect or prevent it early?

(The attending physician will recommend diagnosis and treatment based on the patient’s overall condition, fracture type and degree of displacement, age, activity level, and comorbidities.)