Hip Fractures



Background

Remember analgesia (see analgesia section)

Always assess and record the patient's ability to bear weight


Hip fractures or dislocations

Classification neck of  femur fractures
1. Subcapital 2. Transcervical 3. Basicervical
4. Inter or Sub trochanteric (Extracapsular)

AP and lateral X-rays required plus CXR if fractured. Check sciatic nerve and pulses. For fractures - complete fast-track documentation, add femoral nerve block to opiate analgesia. Admit under the on-call Orthopaedic Team.

Undisplaced fractures of the femoral neck

  • May not be evident radiologically
  • 1% of hip fractures will have a completely normal x-ray
  • Patients may be able to walk with an undisplaced fracture
  • In 5% of cases there may be no Hx of trauma (osteoporotic or pathological # likely)

Intracapsular (subcapital) fractures in young patients are an orthopaedic emergencies.

  • Refer immediately to the duty orthopaedic SpR
  • If inability to bear weight or significant pain on walking obtain an orthopaedic opinion
  • For fractures of pubic rami, please see under 'pelvic fractures'
  • In children beware of Perthes' disease (avascular necrosis aged 3 - 8) and slipped upper femoral epiphysis (occurring around puberty) which requires a lateral radiograph for diagnosis. Please see Hip Pain in Children

Femoral shaft fractures

  • Check and treat ABCs
  • Establish IV access and x-match 4 units
  • Consider femoral nerve block
  • Confirm distal perfusion and sicatic nerve function
  • Apply Thomas or Donway traction splint worn until the patient goes to theatre

Content by Dr Íomhar O' Sullivan. Last review Di ÍOS 10/04/23.