Anatomy
Angle of 125° with shaft in adulthood; angle less in shorter femurs and wider pelvises (sa female). Points up, in and forward (12 – 14°). Big load-bearing and torsion associated with locomotion, are withstood by relatively small neck bone mass, through its tension and compression trabeculae and strong calcar femorale.
Clinical
Classicly presents as: elderly, pain, falls, can’t bear weight, affected leg shortened and externally rotated, often osteoporosis. Fracture can disrupt blood supply to head of femur, with risk of avascular necrosis.
Hip fracture in elderly can lead to pneumonia and associated mortality.
Vignette
William Osler – father of modern medicine – called pneumonia the “friend of the aged” (also known as the “old man’s friend”) i.e., a relatively peaceful way to die. Much better treatment options now, but remains a significant illness.
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