Femur, hoftebrudd
Sist revidert:
Sist revidert av:Frede Frihagen
Definisjon:
Hoftebrudd er intrakapsulære (lårhalsbrudd) eller ekstrakapsulære (pertrokantære). De cervikale kan være dislokerte eller ikke-dislokerte. De trokantære kan være stabile eller ustabile
Forekomst:
Det forekommer omtrent 9.000 hoftebrudd hvert år i Norge. 55% av disse er lårhalsbrudd
Symptomer:
Sykehistorien er typisk med traume, oftest et enkelt fall, og etterfølgende smerter i hofteregionen med nedsatt evne til aktivt å bevege beinet
Funn:
Det aktuelle beinet er ofte opprykket, forkortet og utrotert, og ved bevegelse av beinet vil det være ømhet/smerte i hofteregionen
Diagnostikk:
Diagnosen stilles på klinisk mistanke, og den bekreftes ved røntgen. I tvilstilfeller anvendes MR eller CT
Behandling:
Kirurgi
- Nasjonal kompetansetjeneste for leddproteser og hoftebrudd - nettside
- Norsk ortopedisk forening, Norsk geriatrisk forening og Norsk anestesiologisk forening. Norske retningslinjer for tverrfaglig behandling av hoftebrudd 2018.
- Kold S, et al. Femur, lårhalsbrud. Lægehåndbogen, sist oppdatert 24.06.2019.
- Norsk ortopedisk forening, Norsk geriatrisk forening og Norsk anestesiologisk forening. Norske retningslinjer for tverrfaglig behandling av hoftebrudd 2018. www.legeforeningen.no
- Frihagen F, Nordsletten L, Madsen JE. Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ 2007; 335: 1251-4. British Medical Journal
- Figved W, Opland V, Frihagen F et al. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res 2009; 467: 2426-35. PubMed
- Gjertsen JE, Vinje T, Engesaeter LB et al. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients. J Bone Joint Surg Am 2010; 92: 619-28. PubMed
- Stoen RO, Nordsletten L, Meyer HE et al. Hip fracture incidence is decreasing in the high incidence area of Oslo, Norway. Osteoporos Int 2012; 23: 2527-34. pmid:22246602 PubMed
- Søgaard AJ, Holvik K, Meyer HE, et al. Continued decline in hip fracture incidence in Norway: a NOREPOS study. Osteoporos Int. 2016 Jul;27(7):2217-2222. Epub 2016 Feb 22. PMID: 26902091. PubMed
- Rapport fra Nasjonal kompetansetjeneste for leddproteser og hoftebrudd (2020). Nettside besøkt januar 2021. nrlweb.ihelse.net
- Lofthus CM, Osnes EK, Meyer HE et al. Young patients with hip fracture: a population-based study of bone mass and risk factors for osteoporosis. Osteoporos Int 2006; 17: 1666-72. PubMed
- Parker M, Johansen A. Hip fracture. BMJ 2006; 333: 27-30. PubMed
- Ranhoff AH, Holvik K, Martinsen MI, Domaas K, Solheim LF. Older hip fracture patients: three groups with different needs. BMC Geriatr. 2010 Sep 18;10:65. PMID: 20849652. PubMed
- Sennerby U, Melhus H, Gedeborg R, et al. Cardiovascular diseases and risk of hip fracture. JAMA 2009; 302: 1666-73. Journal of the American Medical Association
- Khalili H, Huang ES, Jacobson BC, et al. Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. BMJ 2012; 344: e372. BMJ (DOI)
- Bakken MS, Schjott J, Engeland A, et al. Antipsychotic Drugs and Risk of Hip Fracture in People Aged 60 and Older in Norway. J Am Geriatr Soc. 2016; 64(6): 1203-9. PMID: 27321599 PubMed
- Torbergsen AC, Watne LO, Wyller TB, et al. Vitamin K1 and 25(OH)D are independently and synergistically associated with a risk for hip fracture in an elderly population: a case control study. Clin Nutr. 2015 Feb;34(1):101-6. Epub 2014 Jan 29. PMID: 24559841. PubMed
- Chana R, Noorani A, Ashwood N, Chatterji U, Healy J, Baird P. The role of MRI in the diagnosis of proximal femoral fractures in the elderly. Injury 2006; 37: 185-9. PubMed
- Oka-Mayumi, Monu-Johnny UV. Americian J Roentgenolog 2004; 182: 283-8. PubMed
- Kirby MW, Spritzer C. Radiographic detection of hip and pelvic fractures in the emergency department. AJR Am Roentgenol 2010; 194: 1054-60. PubMed
- Parker MJ, Raghavan R, Gurusamy K. Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res 2007; 458: 175-9. PubMed
- Helsedirektoratet: Antibiotika i sykehus. 1.8. Ortopedisk kirurgi. Nettsiden besøkt 29.01.21. www.helsedirektoratet.no
- Norsk selskap for trombose og hemostase, Retningslinjer for antitrombotisk behandling og profylakse 2013. Nettside besøkt 14.03.21. app.magicapp.org
- The HEALTH Investigators. Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture. N Engl J Med 2019; 381:2199-2208 . www.nejm.org
- Gjertsen J-E. Should Total Hip Arthroplasty Be Used for Hip Fracture?. N Engl J Med 2019; 381:2261-2262. www.nejm.org
- Dolatowski FC, Frihagen F, Bartels S, et al. Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in Elderly Patients: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am. 2019 Jan 16;101(2):136-144. PMID: 30653043. PubMed
- Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma 2014; 28: 49-55. pmid:23912859 PubMed
- Guay J, Parker MJ, Gajendragadkar PR, Kopp S. Anaesthesia for hip fracture surgery in adults. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD000521. DOI: 10.1002/14651858.CD000521.pub3. DOI
- Simunovic N, Devereaux PJ, Sprague S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609-1616. PubMed
- Gillespie WJ, Walenkamp GHIM. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD000244. Cochrane (DOI)
- Rao SS, Cherukuri M. Management of hip fracture: The family physicin's role. Am Fam Physician 2006; 73: 2195-200. PubMed
- Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 2002;89:622-32. PubMed
- Avenell A, Handoll HHG. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD001880. Cochrane (DOI)
- Eneroth M, Olsson UB, Thorngren KG. Nutritional Supplementation Decreases Hip Fracture-related Complications. Clin Orthop Relat Res 2006; 451: 212-7. PubMed
- McDonough CM, Harris-Hayes M, Kristensen MT, et al. Physical Therapy Management of Older Adults With Hip Fracture. J Orthop Sports Phys Ther. 2021 Feb;51(2):CPG1-CPG81. PMID: 33522384. PubMed
- Edelstein DM, Aharonoff GB, Karp A, Capla EL, Zuckerman JD, Koval KJ. Effect of postoperative delirium on outcome after hip fracture. Clin Orthop Relat Res 2004; 422: 195-200. PubMed
- Damany DS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures. Injury 2005; 36: 131-41. PubMed
- Handoll HHG, Parker MJ. Conservative versus operative treatment for hip fractures in adults. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD000337. DOI: 10.1002/14651858.CD000337.pub2. The Cochrane Library
- Gjertsen JE, Engesaeter LB, Furnes O et al. The Norwegian Hip Fracture Register: experiences after the first 2 years and 15,576 reported operations. Acta Orthop 2008; 79: 583-93. PubMed
- Zlowodzki M, Brink O, Switzer J et al. The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Joint Surg Br 2008; 90: 1487-94. PubMed
- Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev 2006; nr.4: CD001708. Cochrane (DOI)
- Guren E, Figved W, Frihagen F, Watne LO, Westberg M. Prosthetic joint infection-a devastating complication of hemiarthroplasty for hip fracture. Acta Orthop. 2017 Aug;88(4):383-389. Epub 2017 Mar 8. PMID: 28271919. PubMed
- Iversen PO, Sandset PM. Primærprofylakse mot DVT ved kirurgi og andre tilstander. I: Norsk legemiddelhåndbok, sist endret 08.11.2017.
- Feskanich D, Willett W, Colditz G. Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA 2003; 288: 2300-6. PubMed
- Guirguis-Blake JM, Michael YL, Perdue LA et al. Interventions to Prevent Falls in Older AdultsUpdated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2018; 319: 1705-16. pmid:29710140 PubMed
- Kannus P, Parkkari J, Niemi S, et al. Prevention of Hip Fracture in Elderly People with Use of a Hip Protector. N Engl J Med 2000; 343: 1506-13. New England Journal of Medicine
- Roche JJW, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 2006; 331: 1374-6. British Medical Journal
- Roberts SE, Goldacre MJ. Time trends and demography of mortality after fractured neck of femur in an English population, 1968-98: database study. BMJ 2003; 327: 771-4. PubMed
- Meyer HE, Tverdal A, Falch JA et al. Factors associated with mortality after hip fracture. Osteoporos Int 2000; 11: 228-32. PubMed
- Colon-Emeric C, Kuchibhatla M, Pieper C, Hawkes W, Fredman L, Magaziner J et al. The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Osteoporos Int 2003; 14: 879 - 83. PubMed
- Bahl S, Coates PS, Greenspan SL. The management of osteoporosis following hip fracture: have we improved our care? Osteoporos Int 2003; 14: 884 - 8. PubMed
- Frede Frihagen, spesialist i ortopedi, overlege ved Ortopedisk avdeling, Oslo universitetssykehus, Ullevål, Oslo og førsteamanuensis, Institutt for Klinisk Medisin, UiO