Clinical focus: neck of femur fractures

Staff with patient in ambulance

With an unexpectedly high mortality rate, neck of femur (NoF) or hip fractures are a major public health issue with our ageing population. Due to associated consequences of the break, including extended stays in hospital, infections and lack of confidence causing future falls, 10% of patients die within a month and about a third within 12 months.

A serious incident has recently been declared by us after a patient was left at home despite feeling numb in their hip for more than a week; the patient was later found to have a NoF fracture in hospital.

Patients with a NoF fracture may present in the following ways:

  • a sudden inability to bear weight; there may be no history of injury, especially in an elderly patient with confusion or dementia
  • pain may radiate to the knee but the patient feels no pain on movement of the hip
  • the affected leg may be shortened and rotated
  • the patient might be in discomfort with any movement
  • numbness or tingling

A fracture can be associated with a fall but not always; it could be related to a bone disorder or a vascular problem. A thorough patient assessment is needed and if you suspect a fracture, you should straighten the patient’s leg with support and bind as you can; the patient is also likely to require pain relief.

Around 75,000 hip fractures occur each year in the UK and in the elderly this can be life-changing, with some patients never rehabilitating. The National Institute for Clinical Excellence (NICE) recommends that surgery should happen the same day or the day after hospital admission, so these patients need fast, thorough and effective care. For more information on the NICE guidelines, please visit their website.

Published 31st July 2014 

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