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Hip Fracture: Differential Diagnoses & Workup
Updated: Jan 30, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Femoral Head Avascular Necrosis | Hip Overuse Syndrome |
| Femoral Neck Fracture | Hip Pointer |
| Femoral Neck Stress Fracture | Iliopsoas Tendinitis |
| Femur Injuries and Fractures | Slipped Capital Femoral Epiphysis |
Other Problems to Be Considered
The physician treating young athletes must be mindful of several conditions that may manifest with pain that seemingly arise from athletic participation. These include L egg-Calve-Perthes disease, toxic synovitis, rheumatoid arthritis, septic arthritis, hip dislocations, acetabular fractures, and neoplasm.
Workup
Laboratory Studies
- If the diagnosis of hip fracture is still under consideration after taking into account the patient's history and presentation, laboratory studies should be ordered based on the patient and the potential for surgery. Laboratory studies to consider may include the following:
- Complete blood cell (CBC) count
- Electrolytes evaluation
- Serum urea nitrogen value
- Creatinine value
- Glucose level
- Urinalysis (UA)
- Prothrombin time (PTT)
- Activated partial thromboplastin time (APTT)
- Arterial blood gas (ABG) determination
- These studies are used to determine the patient's medical condition before surgery and to allow correction of any abnormalities before surgical intervention.
Imaging Studies
- In addition to the recommended laboratory studies in a patient suspected of having a hip fracture, the physician should also obtain a chest x-ray film and an electrocardiogram (ECG) tracing to further assess the patient's medical condition before any surgical intervention.
- X-ray films are always indicated to determine which type of fracture, if any, is present. Anteroposterior (AP) views of the pelvis and hip and cross-table lateral x-ray films are usually sufficient to evaluate potential fractures. Rotating the affected leg internally or externally can increase the sensitivity of these radiographs.
- If the clinical picture is highly suggestive of a fracture or stress fracture and the x-ray findings fail to demonstrate a fracture, magnetic resonance imaging (MRI), linear tomography, or bone scanning can be useful in defining otherwise imperceptible fractures.
- A bone scan displays a radiographically occult fracture 80% of the time 24 hours after an injury, and it also shows almost all fractures after 72 hours. Negative bone scan findings virtually exclude the diagnosis of a stress fracture.
- MRI is able to show areas of decreased signal in the marrow of the involved bone soon after the injury. Because of the increased prevalence of bilateral involvement, consider performing imaging studies on the contralateral hip when a stress fracture is suggested.
More on Hip Fracture |
| Overview: Hip Fracture |
 Differential Diagnoses & Workup: Hip Fracture |
| Treatment & Medication: Hip Fracture |
| Follow-up: Hip Fracture |
| Multimedia: Hip Fracture |
| References |
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References
Zachazewski JE, Magee DJ, Quillen WS, eds. Athletic Injuries and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:599-604.
DeLee JC, Drez D, eds. Orthopaedic Sports Medicine: Principles and Practice. Vol 2. Philadelphia, Pa: WB Saunders; 1994:1076-80.
Anderson MK, Hall SJ, Martin M, eds. Sports Injury Management. Baltimore, Md: Lippincott Williams & Wilkins; 2000:412-3.
Shin AY, Gillingham BL. Fatigue fractures of the femoral neck in athletes. J Am Acad Orthop Surg. Nov 1997;5(6):293-302. [Medline].
Canavan PK, ed. Rehabilitation in Sports Medicine: A Comprehensive Guide. Stamford, Conn: Appleton & Lange; 1998:265-6.
Davison BL, Weinstein SL. Hip fractures in children: a long-term follow-up study. J Pediatr Orthop. May-Jun 1992;12(3):355-8. [Medline].
Egol KA, Koval KJ, Kummer F, Frankel VH. Stress fractures of the femoral neck. Clin Orthop Relat Res. Mar 1998;348:72-8. [Medline].
Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. Mar 1979;61(2):216-21. [Medline]. [Full Text].
Leboff MS, Narweker R, Lacroix A, et al. Homocysteine levels and risk of hip fracture in postmenopausal women. J Clin Endocrinol Metab. Jan 27 2009;epub ahead of print. [Medline].
Shabat S, Nyska M, Eintacht S, et al. Serum leptin level in geriatric patients with hip fractures: possible correlation to biochemical parameters of bone remodeling. Arch Gerontol Geriatr. Mar-Apr 2009;48(2):250-3. [Medline].
Zarin JS, Zurakowski D, Burke DW. Claw plate fixation of the greater trochanter in revision total hip arthroplasty. J Arthroplasty. Feb 2009;24(2):272-80. [Medline].
Further Reading
Keywords
hip fracture, femoral neck fracture, intracapsular hip fracture, hip stress fracture, femoral neck stress fracture, femoral stress fracture, Garden classification, Colonna classification, Evan classification, broken hip, fractured hip, cracked hip
