Hip fracture

Question 1

Hx

Answer 1

73 yr old F in ED fell at home, tripping over a step, acute onset pain in R hip and groin on hitting the ground. Hx of osteoporosis.

Question 2

Look/ inspection

Answer 2

R leg is shortened and laterally rotated. Bruising and swelling around R hip.

Question 3

Feel

Answer 3

Tenderness around right hip

Question 4

Movement active/passive/restricted

Answer 4

not appropriate

Question 5

other exam results

Answer 5

unable to move right hip

unable to walk

Question 6

DDx

Answer 6

Neck of femur fracture right hip
Hip dislocation
Hip OA

Question 7

Why is fractured neck of femur likely?

Answer 7

Hx of significant trauma on a background of osteoporosis

exam findings: shortened and laterally rotated affected limb

Question 8

Why is hip dislocation unlikely?

Answer 8

hip and leg will be in slight flexion, adduction and medial rotation

Question 9

Why is hip OA unlikely?

Answer 9

prolonged history of hip OA which lasts months to years, groin and thigh pain with stiffness and decreased ROM

Question 10

Investigations

Answer 10

X-ray AP Pelvis

CT scan

Question 11

X-ray AP Pelvis

Answer 11

Garden classification of femoral neck fractures

Question 12

CT scan

Answer 12

used in comminuted fractures

Question 13

no-op tx

Answer 13

observation for high risk pts
medical reason for fall
review bone health

Question 14

op tx

Answer 14

open reduction internal fixation used in displaced fractures in < 65
cannulated screw used in nondisplaced transcervical fractures Garden 1 + 2
Hemiarthroplasty used in Garden 3 + 4 if predicted survival is < 5 yrs
Total Hip Arthroplasty Garden 3 + 4