髋骨骨折是常见的致残原因，一年内的死亡率可达30％。不可修改的风险因素包括低社会经济地位、年龄较大、女性、先前骨折、代谢性骨病和骨恶性肿瘤。可修改的风险因素包括身体质量指数低、骨质疏松症、摔倒风险增加、增加摔倒风险或降低骨矿物密度的药物使用和物质滥用。髋骨骨折表现为前侧腹痛，无法承受重量或缩短、外展、外旋的肢体。通常采用平片诊断，但如果怀疑骨折仍然存在，则应进行核磁共振成像。骨折后24至48小时内进行手术治疗，可优化治疗效果。骨折通常通过手术管理，其方法基于骨折类型和位置；可使用脊椎或全麻。对于手术不好的患者，可以考虑非手术治疗。术前和术后给予抗葡萄球菌抗生素以预防关节感染。也建议使用用于预防静脉血栓栓塞的药物。医生应警惕精神错乱的存在，这是常见的术后并发症。术后早期运动后，进行康复，可以改善治疗效果。随后的护理重点是预防，增加身体活动，进行家庭安全评估，最小化多药使用。还有两种不常见的髋骨骨折：股骨颈应力骨折和不足性骨折。股骨颈应力骨折通常发生在舞者20至30岁、耐力运动员和军人中，通常是由于训练过载引起的。骨强度受损导致的不足性骨折在绝经后妇女中不需要创伤即可发生。如果不被识别和治疗，这些骨折可以发展成高非联合和无血管性坏死的完全和移位骨折。

Hip fractures are common causes of disability, with mortality rates reaching 30% at one year. Nonmodifiable risk factors include lower socioeconomic status, older age, female sex, prior fracture, metabolic bone disease, and bony malignancy. Modifiable risk factors include low body mass index, having osteoporosis, increased fall risk, medications that increase fall risk or decrease bone mineral density, and substance use. Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. Operative management within 24 to 48 hours of the fracture optimizes outcomes. Fractures are usually managed by surgery, with the approach based on fracture type and location; spinal or general anesthesia can be used. Nonsurgical management can be considered for patients who are not good surgical candidates. Pre- and postoperative antistaphylococcal antibiotics are given to prevent joint infection. Medications for venous thromboembolism prophylaxis are also recommended. Physicians should be alert for the presence of delirium, which is a common postoperative complication. Early postoperative mobilization, followed by rehabilitation, improves outcomes. Subsequent care focuses on prevention, with increased physical activity, home safety assessments, and minimizing polypharmacy. Two less common hip fractures can also occur: femoral neck stress fractures and insufficiency fractures. Femoral neck stress fractures typically occur in dancers 20 to 30 years of age, endurance athletes, and military service members, often because of training overload. Insufficiency fractures due to compromised bone strength occur without trauma in postmenopausal women. If not recognized and treated, these fractures can progress to complete and displaced fractures with high rates of nonunion and avascular necrosis.