Femur fracture: Difference between revisions
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**[[Nerve Block: Fascia Iliaca Compartment]] | **[[Nerve Block: Fascia Iliaca Compartment]] | ||
**3 in 1 block (femoral, obturator, lateral cutaneous nerve of thigh) | **3 in 1 block (femoral, obturator, lateral cutaneous nerve of thigh) | ||
** No difference in 2 blocks listed above <ref>Reavley P, et al. Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department. Emerg Med J. 2014 Nov 27.</ref> | ** No difference in 2 blocks listed above which both reduced pain scores in the ED. <ref>Reavley P, et al. Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department. Emerg Med J. 2014 Nov 27.</ref> | ||
*Most fractures, including all displaced, are treated with ORIF | *Most fractures, including all displaced, are treated with ORIF | ||
**Exception is isolated trochanteric fracture often does not require surgery | **Exception is isolated trochanteric fracture often does not require surgery | ||
Revision as of 18:13, 8 August 2015
Background
- Despite good care, proximal fracture 30-day all cause mortality is 22% and grows to 36% at one year[1]
Clinical Features
- History of trauma
- Hip and/or leg pain
Differential Diagnosis
Femur Fracture Types
Proximal
- Intracapsular
- Extracapsular
Shaft
- Mid-shaft femur fracture (all subtrochanteric)
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
Proximal
- Consider AP pelvis in addition to AP/lateral views to compare contralateral side
- Consider MRI if strong clinical suspicion but negative x-ray
Mid-Shaft
- Plain xrays of femur
Management
- Pain control in ED with femoral nerve blocks.
- Nerve Block: Fascia Iliaca Compartment
- 3 in 1 block (femoral, obturator, lateral cutaneous nerve of thigh)
- No difference in 2 blocks listed above which both reduced pain scores in the ED. [2]
- Most fractures, including all displaced, are treated with ORIF
- Exception is isolated trochanteric fracture often does not require surgery
- See individual pages for further discussion
- Type and cross/screen for pts at higher risk of hemorrhage:
- Age > 75 yrs
- Initial Hb < 12
- Peritrochanteric fracture