The treatment of hip fractures is the prototype for the orthopedic management of geriatric patients. Because of the demographics of the USA (increasing age of the population), the incidence of hip fractures will increase in the next few decades, with the yearly incidence increasing to 500,000 in 2040 from 250,000 in 1990. Prevention of hip fractures is becoming increasingly important due to significant morbidity and mortality associated with a hip fracture. Modalities that have been shown to decrease the incidence of geriatric hip fractures include analysis of conditions that predispose to falls, prevention, and treatment of bone fragility, and, possibly, the use of hip protectors. Therefore, especially in patients who already have sustained a hip fracture, reviewing the patient's medications to identify those that may interfere with cognition and balance (e.g., diazepams), evaluating eyesight (poor vision may predispose to a fall), and diagnosing and treating osteoporosis may decrease the risk of subsequent hip fractures.

Classification of hip fractures

It is not the purpose of this chapter to discuss the complete classification of hip fractures and subsequent treatment; however, it is useful to describe hip fractures and the goal of surgical treatment. Femoral neck fractures occur mostly in elderly patients; displaced fractures often are treated with arthroplasty to avoid the known complications of non-union and avascular necrosis and to allow for immediate ambulation. Intertrochanteric hip fractures are almost always treated with internal fixation. This intervention provides a high union rate; with newer implants, unrestricted weightbearing is usually allowed. The goal of treatment of all geriatric hip fractures is a rapid return to the pre-injury ambulatory status, as this has been shown to decrease the morbidity of hip fractures.