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 o  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. Refer fractures to 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 (albeit painfully) with an undisplaced fracture
  • In 5% of cases there may be no history of trauma (osteoporotic or pathological fracture 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 22/02/2004.  Reviewed by Dr ÍOS 18/09/2004, 10/02/2007.   Next review 10/02/2008.