Although the hip joint comprises the acetabulum, the femoral head, the femoral neck, the greater and lesser trochanters, and the proximal femoral shaft, the term "hip fracture" typically connotes an injury to the femoral neck or the region between the greater and lesser trochanters, so-called inter-trochanteric fractures.
Hip fractures may be seen in younger patients with high energy mechanisms of injury (a motor vehicle collision, for instance), but most cases are seen in older patients after a low energy mechanism of injury such as a fall from a standing height. Many of these fractures are associated with osteoporosis, other medical conditions that cause falls, and generalized frailty. These fractures impose great burdens on patients, their families and society.
Consistent with the old saying, “we come into the world under the brim of the pelvis and go out through the neck of the femur,” hip fractures are indeed associated with a high mortality risk. About one third of elderly patients with a low energy hip fracture are apt to die within a year of the injury. Hip fractures from falls are a marker for senescence and decline, though the added biological stress of the fracture and its treatment no doubt contributes to this mortality risk. On the other hand, many hip fracture patients have excellent rehabilitation potential and must be astutely assessed and adeptly managed to optimize post-injury function.
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