- Fat embolism syndrome: petechiae, confusion, respiratory distress 24‑72 hours after fracture
- Avascular necrosis of femoral head: especially in displaced femoral neck fractures
- Periprosthetic fracture or dislocation: after arthroplasty
Osteoporotic Hip Fracture
Must-Not-Miss / Red Flags
Patient Explanation
“You’ve broken your hip, which is common in older adults with weak bones. We’ll operate to fix it and get you walking again as soon as possible.”
Board Fact
“Surgical repair within 48 hours of admission reduces mortality and improves functional outcomes in hip fracture patients.”
ICD-10
S72.009A
Definition & Core Concept
An osteoporotic hip fracture is a low‑energy fracture of the proximal femur (femoral neck or intertrochanteric region) occurring in elderly patients with decreased bone density, typically from a fall from standing height.
Epidemiology & Risk Factors
- 1.6 million hip fractures globally per year; expected to rise with aging population
- 1‑year mortality after hip fracture: 20‑30%
- Risk factors: female sex, advanced age, osteoporosis, falls, smoking
Clinical Vignette
An 82‑year‑old woman with osteoporosis trips on a rug and falls, landing on her right hip. She is unable to stand. X‑ray reveals a displaced right femoral neck fracture. She is taken to the OR within 24 hours for a bipolar hemiarthroplasty.
Pearls & Pitfalls
- Delay to surgery >48 hours doubles the risk of mortality at 30 days.
- All hip fracture patients should be evaluated and treated for osteoporosis – a fragility fracture is a sentinel event.
Discharge & Follow-Up
Post‑op: PT/OT rehabilitation; home safety evaluation to prevent future falls. Bone density scan (DEXA) if not done in past 2 years. Continue osteoporosis pharmacotherapy for at least 3‑5 years.
Literature & Guidelines
AAOS 2024 Clinical Practice Guideline on Hip Fractures in the Elderly. PMID: 38720001.