Hip fractures March 2018 | by EMauthor Introduction •Most commonly an osteoporotic fractures of the elderly caused by a fall •In some cases the injury may seem trivial •In some cases the pain from hip fractures may radiate to the knee and knee pain may be the chief complaint •Inability to weight bear is the most reliable feature and a fracture should be excluded if this the case Follow the fast track policy for fracture neck of femur •Administer analgesia, ideally iv opiates titrated to the patient’s need, this should be done prior to x-ray examination •Examine patient for co-morbid conditions (heart failure, chest conditions, anticoagulation) and assess mobility, mental state and social circumstances •Take blood for FBC, U&E, x-match ,and order an ECG •Set up an iv line and correct dehydration if present •Order pelvic x-ray and lateral hip, CXR should be done with positive hip x-ray •Fascia iliaca block or femoral block •Refer to orthopaedics Non weight bearing in the elderly after a fall •Exclude pubic rami fractures or distal limb fractures •It could be due to impacted neck of femur fracture which may not show on initial x-ray oIf there is a low suspicion of #NOF then a medical or frailty referral may be appropriate oIf there is a high suspicion of #NOF despite a seemingly normal X-ray, refer to orthopaedics Key guidelines NICE / SIGN: RCEM: |
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