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Femur, hoftebrudd

Sist revidert:
Sist revidert av:
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 

 

  1. Norsk ortopedisk forening, Norsk geriatrisk forening og Norsk anestesiologisk forening. Norske retningslinjer for tverrfaglig behandling av hoftebrudd 2018. www.legeforeningen.no  
  2. 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  
  3. 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  
  4. 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  
  5. 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  
  6. 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  
  7. Rapport fra Nasjonal kompetansetjeneste for leddproteser og hoftebrudd (2020). Nettside besøkt januar 2021. nrlweb.ihelse.net  
  8. 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  
  9. Parker M, Johansen A. Hip fracture. BMJ 2006; 333: 27-30. PubMed  
  10. 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  
  11. 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  
  12. 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)  
  13. 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  
  14. 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  
  15. 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  
  16. Oka-Mayumi, Monu-Johnny UV. Americian J Roentgenolog 2004; 182: 283-8. PubMed  
  17. Kirby MW, Spritzer C. Radiographic detection of hip and pelvic fractures in the emergency department. AJR Am Roentgenol 2010; 194: 1054-60. PubMed  
  18. Parker MJ, Raghavan R, Gurusamy K. Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res 2007; 458: 175-9. PubMed  
  19. Helsedirektoratet: Antibiotika i sykehus. 1.8. Ortopedisk kirurgi. Nettsiden besøkt 29.01.21. www.helsedirektoratet.no  
  20. Norsk selskap for trombose og hemostase, Retningslinjer for antitrombotisk behandling og profylakse 2013. Nettside besøkt 14.03.21. app.magicapp.org  
  21. The HEALTH Investigators. Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture. N Engl J Med 2019; 381:2199-2208 . www.nejm.org  
  22. Gjertsen J-E. Should Total Hip Arthroplasty Be Used for Hip Fracture?. N Engl J Med 2019; 381:2261-2262. www.nejm.org  
  23. 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  
  24. 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  
  25. 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  
  26. 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  
  27. 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)  
  28. Rao SS, Cherukuri M. Management of hip fracture: The family physicin's role. Am Fam Physician 2006; 73: 2195-200. PubMed  
  29. Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 2002;89:622-32. PubMed  
  30. 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)  
  31. Eneroth M, Olsson UB, Thorngren KG. Nutritional Supplementation Decreases Hip Fracture-related Complications. Clin Orthop Relat Res 2006; 451: 212-7. PubMed  
  32. 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  
  33. 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  
  34. 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  
  35. 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  
  36. 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  
  37. 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  
  38. 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)  
  39. 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  
  40. Iversen PO, Sandset PM. Primærprofylakse mot DVT ved kirurgi og andre tilstander. I: Norsk legemiddelhåndbok, sist endret 08.11.2017.
  41. 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  
  42. 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  
  43. 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  
  44. 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  
  45. 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  
  46. Meyer HE, Tverdal A, Falch JA et al. Factors associated with mortality after hip fracture. Osteoporos Int 2000; 11: 228-32. PubMed  
  47. 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  
  48. 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