An Overview of Fractures of the Proximal Femur

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An Overview of Fractures of the Proximal Femur

• Jeffrey Hallett
• Consultant Orthopaedic Surgeon
• Ipswich, U.K.

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Association for the Rational Treatment of
Fractures

• Amsterdam 1995.
• Gus Sarmiento, Miami.
• James Waddell, Toronto.
• UK Registered Company 1997.
• UK Registered Charity 2002. ?

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Fractures of the Proximal Femur

• A huge economic and human problem.

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UK Figures.

• 47,500 fractures per year in 2000.
• 120,000 expected by 2015.
• Total cost 726 million. (in 2000)
• Hospital 226 million.
• Social Care 490 million.
• 3 female 1 male.
• Hospital stay 20 days.
• Economic cost of hip fractures in the UK Univ.
  York 2000 ?

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USA figures.

• Proximal femoral fractures doubled in the USA
  from 1960s to 1980s.
• In 2003 more than 300,000 per year with
  healthcare costs 10 billion.
• By 2050 they expect 650,000 per year.
• Revision surgery also needed in 15 to 30.
• Eisler et al. JOT Sept. 2003 ?

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Human Cost.

• Increase in dependency.
• 3 month mortality 5 to 24
• 1 year mortality 20 to 35
• Men do less well than women.
• Pedersen et al. J.Am.Ger.Soc. 2008. ?

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Fractures of the Proximal Femur

• Look beyond the bone!

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William Shakespeare

• Seven Ages of Man.
• As You Like It. ?

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First Age

• Infant

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Second Age

• Schoolboy

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Third Age

• Lover

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Fourth Age

• Soldier

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Fifth Age

• Justice

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Sixth Age

• Pantaloon

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Seventh Age

• Second Childhood

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The Infant

• Fractures rare.
• Heal well?
• Fracture from sepsis?
• Life threatening.
• Danger to development of femoral head. ?

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Fracture in baby or young child.

• Is there a possibility that this is a
  non-accidental injury? ?

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The Schoolboy

• Accident prone.
• Severe violence needed.
• Falls from trees or climbing frames.
• RTA is usual cause.
• Slipped epiphysis in low trauma, needs metabolic
  checks. ?

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Bone Texture

• Simple Bone Cyst.
• Most common.
• Non-malignant.
• Parent worries.
• Careful prognosis. ?

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The advantage of treating childrens fractures?

• The fractures are in children! ?

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The Lover

• Young adult.
• Sports, fights and M/Cs.
• Girls on horses.
• Associated damage.
• Good bone and healing. ?

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The soldier

• Violent fractures.
• RTA commonest.
• Expensive sports.
• DIY accidents.
• Critical for career.
• Gunshot and bombs.
• Multiple injuries. ?

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The Justice

• Career and community seniority.
• Less fit and agile.
• Midlife crisis and large M/Cs.
• Sub-trochanteric fractures.
• Pathological fractures. ?

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The Pantaloon
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Pantaloons

• Pantaloons are tight-fitting trousers (or pants).
• Worn by older men in old Venice.
• Became a disrespectful term for well-off but
  foolish old men. ?

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Modern Pantaloon
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The Pantaloon

• Tendency to simple falls.
• Osteoporosis.
• Pathological fractures Tumours
• Difficult sub-trochanteric.
• ?Primary hip replacement.
• Need to remove devices for THR later. ?

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Second Childhood

• Sans teeth, sans eyes, sans taste, sans
  everything
• Child-like dependency. ?

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Second Childhood

• Now a large population.
• 90 no longer rare.
• Osteoporosis.
• Secondary tumours.
• Bone shatters or crumbles.
• Fractures around prostheses.
• Need for rehabilitation and social teams.
• Often a terminal event. ?

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Treat the patient - not just the
fracture! ?
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The Circle of Life
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END