Hip Fracture and Fall Risk

A hip fracture is a break in the proximal femur, commonly involving the femoral neck, intertrochanteric region, or subtrochanteric region. In an older adult, a ground-level fall may be enough to fracture bone weakened by osteoporosis. The fracture causes pain, muscle spasm, and loss of mechanical support, so the patient may be unable to stand or bear weight. The classic presentation is sudden hip or groin pain, inability to walk, and a shortened, externally rotated leg. That appearance is helpful but not required. An impacted or nondisplaced fracture may leave the leg looking normal; persistent groin pain or pain with gentle movement after a fall still warrants investigation. The fall itself is a second clinical problem. Orthostatic hypotension, dysrhythmia, hypoglycaemia, infection, impaired vision, weakness, urgency to toilet, environmental hazards, and medications such as sedatives or antihypertensives may have contributed. Repairing the fracture without identifying why the person fell leaves the next injury waiting to happen. For adults aged 18 years and older, definitive surgical repair should occur within 48 hours of hospital admission when clinically feasible. The target is not...