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Does it make a difference in recovery for patients based on the type of hip fracture they have? My aging aunt has what's called an intertrochanteric hip fracture. I got the impression from the hospital staff that this is the worst kind. Why is that?

There are many different types of fractures classified by location and specific type. For example, in the hip, the most common fractures in older adults affect the femur (thigh bone). These fractures include:

  • femoral neck
  • femoral head
  • subtrochanteric
  • intertrochanteric

    Femoral neck fracture is a fracture in the femur (thighbone). The break is between the (long part of the femur) and the round round head at the top of the femur. This is where the femoral neck attaches the shaft to the head. These fractures often damage the blood supply to the femoral head. Loss of blood to the top of the bone can lead to death of the bone cells. This condition is called avascular necrosis.

    Femoral head fracture is a break in the femoral head. This is usually the result of high-energy trauma. Dislocation of the hip joint often occurs with this fracture. Subtrochanteric fracture involves the shaft. The break is right below the lesser trochanter (bony knob on the femur). Subtrochanteric fractures may also go down the shaft of the femur.

    When the break is between the greater and lesser trochanter, it's considered an intertrochanteric fracture. This is the most common type of hip fracture. The prognosis for bony healing is usually pretty positive if the patient is in good health.

    But older age, poor nutrition, and poor health (especially combined together) puts a patient at risk for a poor prognosis. Immobilization after a hip fracture increases the risk of infections that can be life-threatening. A simple urinary tract infection or pneumonia can compromise the health of an older adult hospitalized with hip fracture. Deep vein thrombosis (blood clot) is also a risk in these cases.

    Many people beat the odds. So just having the risk factors doesn't guarantee that your aunt will have a poor outcome. There may be other health issues or concerns that caused the hospital staff to react this way. You may need more information before coming to any firm conclusions.

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