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Hip fractures are fractures that occur in the upper third of the thigh bone, called the femur. These fractures can be grouped into two types: intracapsular fractures, which are fractures that happen within the capsule of the hip joint; and extracapsular fractures, which are fractures that happen outside the capsule. One of the most common sites for a hip fracture is at the femoral neck and this is a type of intracapsular fracture.
Now, the hip joint, also called the acetabulofemoral joint, is a ball and socket joint formed between the acetabulum of the hip bone and the head of the femur. The articulating bones are covered by hyaline cartilage and a joint capsule, which is reinforced on the outside by strong ligaments. This makes the joint strong and stable, allowing it to connect the free bones of the lower limb to the pelvic bones. The hip joint allows multiaxial movements, but is also important for weight-bearing and providing stability.
Now, intracapsular fractures are caused by trauma and osteoporosis. Low bone mass due to osteoporosis causes the bones to become more fragile, making them more prone to breaking. Because of this, intracapsular fractures are also called fragility fractures, because they typically occur after minimal trauma, like falling from a chair. On the other hand, extracapsular fractures are typically caused by severe direct trauma, like a car crash.
Now, the main blood supply for the femoral head comes from the lateral femoral circumflex artery that travels along the femoral head. This artery is often compromised during a hip fracture which can cause complications like avascular necrosis of the femoral head. Furthermore, reduced blood flow means slower healing which leads to longer periods of immobility and hospitalization. This increases the risk of developing thrombotic complications, like deep vein thrombosis and pulmonary emboli as well as other complications like infections.
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