By: Terry R. Yochum, DC, DACBR, Fellow, ACCR and Michael S. Barry., DC, DACBR
A Potentially Life-Threatening Circumstance
This 75-year-old female patient tripped going down her basement stairs and heard a “snap.” This resulted in osseous injury. Can you tell the location and the extent of the injury?
Figure 1 Diagnosis: There is a comminuted intertrochanteric fracture of the proximal femur. The fracture line extends from the greater trochanter inferiorly. Observe also the avulsion fracture of the lesser trochanter. Therefore, there are in fact two fractures of the patient’s proximal femur.
Fractures around the proximal femur are relatively uncommon in young to middle-aged patients, with a sharp increase in the geriatric population. Severe trauma is usually necessary to fracture the proximal femur in the young and middle years, while only moderate to minimal force may produce a fracture in the osteoporotic bone of the elderly.
The overall incidence of all types of fractures of the proximal femur shows a 2:1 female to male ratio; however, there is a 5:1 female predominance of intracapsular fracture. The average age is approximately 70 years. It has been estimated that 10% of white females and 5% of white males sustain a fracture of the proximal femur by 80 years of age. Many elderly patients with fractures of the proximal femur die within six months of the original injury. This occurs secondary to pulmonary or cardiac complications. Therefore, fractures of the proximal femur and their attendant sinister complications represent a major health hazard to the elderly and constitute a significant public health issue because of their frequency, morbidity, and cost.
Types of Hip Fractures
The types of hip fractures are divided into intracapsular and extracapsular, as determined by the relationship of the fracture line to the joint capsule. In general, intracapsular fractures have a high incidence of nonunion and avascular necrosis due to probable disruption of the tenuous blood supply.
The standard radiographic examination of the hip includes AP pelvis, AP hip (involved side) and oblique or frog-leg projections. If fracture is suspected clinically, but X-ray evaluation is normal, repeat X-rays in 7–10 days or advance imaging (bone scan or MRI) is recommended.
- Yochum TR, Rowe LJ. Essentials of Skeletal Radiology, 2nd ed. Baltimore, MD: Williams & Wilkins, 1996.
About the Authors
Dr. Terry R. Yochum is a second generation Chiropractor and a cum laude graduate of the National College of Chiropractic, where he subsequently completed his radiology specialty. He is a Diplomate of the American Chiropractic Board of Radiology and served as its vice-president and president for seven years (1983–1990).
Dr. Michael S. Barry is a 1988 cum laude graduate of Palmer College of Chiropractic. He completed a three-year radiology residency at Logan College of Chiropractic following two years of clinical practice in Las Vegas, Nevada. He received his diplomate in radiology from the American Chiropractic Board of Radiology in 1992.