Femur fracture: Difference between revisions
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==Background== | |||
{{Femur fracture types}} | {{Femur fracture types}} | ||
==Clinical Features== | |||
== | ==Differential Diagnosis | ||
{{Hip pain DDX}} | |||
==Diagnosis== | |||
[[File:Location of femur fracture.png|thumb|Location of femur fractures]] | |||
* Imaging | * Imaging | ||
**Consider AP pelvis in addition to AP/lateral views to compare contralateral side | **Consider AP pelvis in addition to AP/lateral views to compare contralateral side | ||
**Consider MRI if strong clinical suspicion but negative x-ray | **Consider MRI if strong clinical suspicion but negative x-ray | ||
==Management== | |||
*Most fx, including all displaced fx, are treated with ORIF | *Most fx, including all displaced fx, are treated with ORIF | ||
**Exception is isolated trochanteric fx often does not require surgery | **Exception is isolated trochanteric fx often does not require surgery | ||
| Line 14: | Line 22: | ||
**Peritrochanteric fx | **Peritrochanteric fx | ||
*Despite good care, 30-day all cause mortality is 22% and grows to 36% at one year<ref>Lawrence, VA, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002; 162(18):2053-7.</ref> | *Despite good care, 30-day all cause mortality is 22% and grows to 36% at one year<ref>Lawrence, VA, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002; 162(18):2053-7.</ref> | ||
==See Also== | ==See Also== | ||
Revision as of 21:53, 8 June 2015
Background
Femur Fracture Types
Proximal
- Intracapsular
- Extracapsular
Shaft
- Mid-shaft femur fracture (all subtrochanteric)
Clinical Features
==Differential Diagnosis
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
- Hip bursitis
- Psoas abscess
- Piriformis syndrome
- Meralgia paresthetica
- Septic arthritis
- Obturator nerve entrapment
- Avascular necrosis of hip
Diagnosis
- Imaging
- Consider AP pelvis in addition to AP/lateral views to compare contralateral side
- Consider MRI if strong clinical suspicion but negative x-ray
Management
- Most fx, including all displaced fx, are treated with ORIF
- Exception is isolated trochanteric fx often does not require surgery
- Skeletal traction is not beneficial
- Type and cross/screen for pts at higher risk of hemorrhage:
- Age > 75 yrs
- Initial Hb < 12
- Peritrochanteric fx
- Despite good care, 30-day all cause mortality is 22% and grows to 36% at one year[1]
See Also
References
- ↑ Lawrence, VA, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002; 162(18):2053-7.