Hip Fracture in Emergency Medicine Treatment & Management

  • Author: Moira Davenport, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 2, 2012
 

Prehospital Care

  • Prehospital treatment of a patient who complains of hip pain should include immobilization on a stretcher.
  • If the patient is a victim of multiple traumas, address the ABCs and immobilize the cervical spine as appropriate.
  • If fracture or deformity of the femur is obvious, apply a traction splint and place an intravenous (IV) line for hydration.
  • If the patient is hypotensive or tachycardic, initiate crystalloid fluid bolus and place patient on supplemental oxygen.
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Emergency Department Care

  • If the patient is a victim of trauma, attend to the ABCs first and conduct a thorough search for other possible injuries.
  • In cases of obvious femur fracture, immobilize the patient, place 2 large-bore IV lines for hydrations and possible transfusion, restrict the patient's oral intake to nothing by mouth (NPO), and obtain specimens for preoperative labs if necessary.
  • Orthopedic treatment decisions vary significantly among different practitioners, thus early consultation for all hip fractures is recommended.
  • Initiate appropriate parenteral analgesia as soon as possible.
  • Ultrasound-guided femoral nerve blocks may also be used to achieve adequate analgesia.[14]
  • Femoral head fractures
    • Type 1: Orthopedic consultation in the ED should be obtained. Treatment is to reduce dislocated femoral head and fracture fragment as soon as possible to avoid avascular necrosis. Small fracture fragments may need to be removed. If a single attempt at closed reduction fails, then open reduction and internal fixation (ORIF) is the next treatment of choice.
    • Type 2: Early orthopedic consultation for admission and arthroplasty is recommended.
  • Femoral neck fractures
    • Type 1: Some practitioners handle these fractures nonoperatively with initial immobilization in selected patients, while others prefer operative treatment in all patients.
    • Types 2, 3, and 4: Management usually includes ORIF or arthroplasty; however, some impacted fractures can be treated conservatively. Early orthopedic consultation is recommended.
  • Trochanteric fractures
    • Type 1: Management is most often conservative, and orthopedic consultation is recommended.
    • Type 2: These fractures usually are treated with reduction and internal fixation, except in older or debilitated patients in whom conservative treatment is appropriate.
  • Intertrochanteric fractures
    • Apply traction or a traction splint.
    • Note the potential for significant blood loss. IV fluid resuscitation is generally recommended.
    • Stable and unstable fractures usually are treated with ORIF unless the patient is not an operative candidate for other reasons.
    • Early orthopedic consultation is recommended.
  • Subtrochanteric fractures
    • Significant hemorrhage is common, and IV fluid resuscitation is frequently necessary.
    • ED application of traction or traction splint is necessary.
    • Properly evaluate the entire patient to rule out associated severe injuries.
    • Consult orthopedic surgeon for admission and ORIF for most patients.
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Consultations

Orthopedic surgery; vascular surgery or neurology, if necessary

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Contributor Information and Disclosures
Author

Moira Davenport, MD  Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital

Moira Davenport, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francis Counselman, MD, FACEP  Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Gigi R Madore, MD, and Geoff Winkley, MD, to the development and writing of this article.

References

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Shenton line and angular anatomy of the femur.
Femoral head fractures. Top diagram is a single-fragment femoral head fracture. Bottom diagram is a comminuted femoral head fracture.
Femoral neck fractures. Top diagram is a nondisplaced, or incomplete, femoral neck fracture. Bottom diagram is an impacted femoral neck fracture.
Partially displaced femoral neck fracture.
Completely displaced femoral neck fracture.
Trochanteric fractures. Top diagram is a nondisplaced trochanteric fracture. Bottom diagram is a displaced trochanteric fracture.
Intertrochanteric fractures. Top diagram is a single fracture line intertrochanteric fracture. Bottom diagram is a displaced, or multiple fracture line, intertrochanteric fracture.
 
 
 
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