Even with good X-rays a small number of hip fractures are not discovered at the initial evaluation. It is extremely important to get satisfactory x-rays of the hip and knee joint to make sure these regions are not also fractured. The standard x-ray views are an anteroposterior (AP) view of the whole thigh bone from hip to knee and a lateral view of the shaft. CT or MRI scanning is not usually needed for these fractures. X-rays of the thigh are a vital part of the evaluation of this injury. Routine tests are done to evaluate blood loss and general body biochemistry prior to an anesthetic. Careful palpation of the leg, paying attention to the knee and shin as well as the thigh and hip, may give an indication of other injuries. The limb will be stabilized with splints, sandbags or skin traction. The vascular and nerve supply of the limb will be carefully checked. The patient will be checked carefully for other injuries especially in the case of a high energy accident with its potential to cause multiple traumas. In the Emergency Room the patient will be further assessed for shock and blood loss as this can be significant. The patient should be kept warm and still. Usually the leg will need to be splinted prior to transport to the hospital. The leg will be assessed for wounds, sensation and blood supply. The shock status of the patient will also be evaluated. Symptomsįirst aid evaluation at the scene of the accident will include questions about the nature of the accident, site of pain and ability to move the leg. An open fracture in which the bone comes out through the skin is an especially severe problem. The force needed to break the thigh bone often causes a lot of damage to the other structures in the thigh. This is particularly true of femur fractures. Injury to the muscles, tendons, ligaments, skin, blood vessels and nerves may be more important than the broken bone. The bone injury is only a part of the total picture when a fracture occurs. This may occur in a car accident when the knee strikes the dashboard and the force is transmitted up the bone. This causes a spiral fracture of the bone.Ĭompression along the line of the bone causes a transverse fracture. This may result in a short oblique fracture or a three-part fracture with a short triangular fragment.Ī twisting force can be applied to the thigh bone when the foot or lower leg is trapped and the weight of the upper body is rotating. Impact against the thigh causes a bending force that compresses one side of the bone and stretches the other.
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