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**Chapter 5**

**Provisional chapter**

**Hip Fracture: Anatomy, Causes, and Consequences**

**Hip Fracture: Anatomy, Causes, and Consequences**

DOI: 10.5772/intechopen.75946

Fall-induced hip fracture is a major worldwide health problem among the elderly population. Nowadays, hip replacement surgery represents a big part of the orthopedic surgeons' workload and has associated remarkable clinical and social cost implications. Hip fractures have several complications including medical and surgical treatment. A significant number of biomechanical models have been introduced to study hip fracture risk. The purpose of proposing the biomechanical models for predicting the hip fracture risk is to introduce prevention and protection activities that may reduce the number of hip fractures. For accurate prediction of hip fracture risk, the fracture procedure and the parameters that affect the risk of hip fracture should be well studied. The objective of this study is to investigate in-depth the hip fracture anatomy, causes, and consequences.

**Keywords:** hip fracture causes, hip anatomy, fall, hip impact force, hip fracture

Low-trauma hip fracture has become a common health problem among the elderly all over the world [1–21], mainly due to the population aging and the prevalence of osteoporosis. Of all osteoporotic fractures, hip fracture has the highest morbidity and mortality rate [22]. Approximately 50% of patients have permanent functional disability greater than that before fracture [23, 24]. The incidence of hip fracture appears to be increasing in many countries [10], and the total number of hip fractures is estimated to be more than five million by 2050 [25]. Socioeconomic impacts of hip fracture are twofold. On the one hand, hip fracture increases the morbidity and mortality in the elderly [26–28]; on the other hand, it is a substantial source of healthcare expenditure [29, 30]. Therefore, there is an urgent need to accurately assess hip fracture risk and then develop preventive and protective measures. In this chapter, hip

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Masoud Nasiri Sarvi

Masoud Nasiri Sarvi

**Abstract**

consequences

**1. Introduction**

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.75946

#### **Hip Fracture: Anatomy, Causes, and Consequences Hip Fracture: Anatomy, Causes, and Consequences**

DOI: 10.5772/intechopen.75946

#### Masoud Nasiri Sarvi Masoud Nasiri Sarvi

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.75946

**Abstract**

Fall-induced hip fracture is a major worldwide health problem among the elderly population. Nowadays, hip replacement surgery represents a big part of the orthopedic surgeons' workload and has associated remarkable clinical and social cost implications. Hip fractures have several complications including medical and surgical treatment. A significant number of biomechanical models have been introduced to study hip fracture risk. The purpose of proposing the biomechanical models for predicting the hip fracture risk is to introduce prevention and protection activities that may reduce the number of hip fractures. For accurate prediction of hip fracture risk, the fracture procedure and the parameters that affect the risk of hip fracture should be well studied. The objective of this study is to investigate in-depth the hip fracture anatomy, causes, and consequences.

**Keywords:** hip fracture causes, hip anatomy, fall, hip impact force, hip fracture consequences

### **1. Introduction**

Low-trauma hip fracture has become a common health problem among the elderly all over the world [1–21], mainly due to the population aging and the prevalence of osteoporosis. Of all osteoporotic fractures, hip fracture has the highest morbidity and mortality rate [22]. Approximately 50% of patients have permanent functional disability greater than that before fracture [23, 24]. The incidence of hip fracture appears to be increasing in many countries [10], and the total number of hip fractures is estimated to be more than five million by 2050 [25]. Socioeconomic impacts of hip fracture are twofold. On the one hand, hip fracture increases the morbidity and mortality in the elderly [26–28]; on the other hand, it is a substantial source of healthcare expenditure [29, 30]. Therefore, there is an urgent need to accurately assess hip fracture risk and then develop preventive and protective measures. In this chapter, hip

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

anatomy is first reviewed, and hip fractures are classified by anatomic location. Then, prevalence of hip fracture is presented, followed by a description of the significance of accurately assessing hip fracture risk.

More than 90% of all hip fractures occur in falls [36] as the femur is subjected to a high-level impact force. As shown in **Figure 1(b)**, in a sideways fall, the greater trochanter and the femoral head are subjected to the impact and the joint force, respectively, from the ground and the acetabulum. The forces produce a moment at the intersection of the neck-shaft axes. Muscles that are attached to the femur also produce forces during the fall. As it is shown in **Figure 1(b)**, the applied forces in a fall are mainly on the proximal femur, and it may explain why the majority of fall-induced hip fractures occur at the proximal femur [37]. A hip fracture refers to any fracture of the proximal femur down to a level of approximately 5 cm below the lower border of the lesser trochanter [38]. The extent of the break depends on the forces that are involved.

Hip Fracture: Anatomy, Causes, and Consequences http://dx.doi.org/10.5772/intechopen.75946 69

Hip fracture is usually caused by an applied force that exceeds the strength of the femur bone [39]. Therefore, any situation that either induces a high level of force on the femur bone or

The main cause of hip fracture is falling (90–92%) [36, 40–42], in particular falling in sideways direction (63–69% in fall-related fractures) [8, 43], as it induces a high level of force on the femur. Parameters that increase the risk of fall and apply a high level of force on the femur,

• Impaired neuromuscular coordination and neurological diseases (e.g., hemiplegia, Parkin-

In the elderly, most fractures occur after a low-trauma fall, which would not cause any severe injury to a healthy individual. Therefore, low bone strength is another main cause of hip fracture. Osteoporosis as a progressive bone disease, which is characterized by decreases in bone mass and density, has been identified as one of the main contributors of hip fracture [46, 47]. Osteoporosis advances when bone resorption exceeds bone formation, and therefore it is more common among the elderly [48]. Approximately three to four out of ten women over the age of 50, and one in eight men, suffer osteoporotic fracture in their lifetime [49].

Apart from osteoporosis, several other causes may reduce the strength of the bone such as bone cancer and medical side effects [38]. Other factors associated with reduction in bone

decreases the bone strength should be considered as a hip fracture cause.

• Inability to effectively use the arms to reduce the energy of the fall

• Reduced soft tissue padding over the hip [44, 45]

**3. Hip fracture causes**

especially in the elderly, are:

• Impaired muscle reactions

• Slow reflex response

• Impaired vision

son's disease)

strength include [38]:

• Mental impairment and confusion
