The estimated incidence of hip fractures in the United States is about 80 per 100,000 population. 27 The incidence increases with age and doubles for each decade past the age of 50. The incidence is about two to three times higher in women than men and fractures are more common in white than nonwhite women.
The possibility of elder abuse should be considered in all elderly patients with falls and fractures. Evidence of physical abuse such as bruises and burns, especially if they are unexplained, and of various ages and certain patterns should raise the physician's clinical suspicion of abuse. Patterns or well-defined shapes, such as an emersion pattern or rope or restraint marks on the wrists or ankles, should also raise suspicion. Signs of neglect, such as dehydration, malnutrition, poor hygiene, extensive bed sores, urine burns or excoriations, and fecal impactions, should also increase suspicion for elder neglect. Interactions between family or caregivers and the patient should be observed and Social Services should be consulted and abuse reported as required by law when appropriate. 28
Hip fractures are classified as femoral head and neck (intracapsular) and trochanteric, intertrochanteric, and subtrochanteric (extracapsular) ( Fig 265-16). The prognosis for successful union and restoration of normal function varies considerably with the fracture.
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