Lightning Learning: Hip Fractures
Hip or neck of femur fractures often results from a fall onto the hip. They classically present as shortened and externally rotated. Pain is worsened on movement but is usually present at rest.
They are broadly split into intracapsular and extracapsular fractures. This is important as intracapsular fractures have an increased risk of avascular necrosis and non-union.
Management is surgical fixation ideally within 24 hours of presenting. In the ED, early analgesia with regular review is key. Most departments also use fascia iliaca nerve block to reduce opioid requirements.
Most of these fractures are frailty-related. Be sure to assess for any other problems that may delay surgery.
Plain radiographs are usually adequate for diagnosis, though ongoing pain in a normal radiograph should be investigated further (CT/plain radiograph).
To avoid missing fractures use Shenton’s Line from the inferior neck of femur to the inferior aspect of superior pubic ramus. Ensure no steps in cortex, or sclerotic lines across the neck.