Proximal Femur Fracture: A Modern Overview

 “Each year, more than 250,000 hip fractures occur in the United States, resulting in considerable patient mortality and morbidity.”

  • Radiological Society of North America

Proximal femur fracture is more than just a broken bone-it’s a life-changing event, especially for older adults. With populations aging worldwide, the number of these injuries is on the rise, making it crucial for clinicians and patients alike to understand the latest in diagnosis, treatment, and recovery. Let’s dive into the essentials every professional should know.

What Is a Proximal Femur Fracture?

A proximal femur fracture-often called a hip fracture-involves a break in the upper part of the thighbone, close to the hip socket. This region includes the femoral head, neck, and the trochanteric area. The hip joint itself is a marvel, bearing our weight and enabling smooth, pain-free movement. When fractured, this joint’s stability and function are severely compromised.

Who’s at Risk?

The majority of proximal femur fractures occur in adults over 50, with women affected two to three times more frequently than men, largely due to osteoporosis and increased fall risk. However, high-energy trauma can cause these fractures in younger individuals as well.

Recognizing the Symptoms

Symptoms are often dramatic and unmistakable:

  • Immediate, severe pain in the groin or hip region

  • Inability to stand or walk

  • The affected leg may appear shorter and turned outward

  • Swelling, bruising, and stiffness around the hip

These signs demand prompt evaluation-delays can worsen outcomes.

How Are Proximal Femur Fractures Diagnosed?

Diagnosis starts with a careful history and physical exam, but imaging is the gold standard:

  • X-rays: Usually reveal the fracture and its type

  • CT or MRI: Used if X-rays are inconclusive or to detect subtle or complex injuries

A proximal femoral fracture can be classified based on location: femoral head, neck (intracapsular), or trochanteric (extracapsular).

Treatment Strategies: What Works Best?

Early intervention is key! Management depends on age, fracture type, and overall health:

  • Younger patients: Surgical fixation with screws or plates is often preferred to preserve the natural hip.

  • Older adults: Early prosthetic replacement (hemiarthroplasty or total hip replacement) lowers mortality and speeds up recovery for neck of femur fractures.

  • Stable intertrochanteric fractures: Sliding hip screws are the standard.

  • Comminuted or unstable fractures: Intramedullary nails provide superior stability.

Rehabilitation starts early-sometimes within days of surgery-to restore mobility and independence.

Complications and Prognosis

Without timely treatment, complications like non-union, avascular necrosis, and deep vein thrombosis can occur. However, with modern surgical techniques and multidisciplinary care, most patients can expect a return to function, though recovery may be prolonged.

The Takeaway

A proximal femur fracture is a serious injury, especially in the elderly, but advances in diagnosis, surgical techniques, and rehabilitation are improving outcomes every year. Early recognition and tailored treatment make all the difference.

Curious about specific surgical options or rehabilitation protocols? Let’s explore your next questions

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