Hip Fracture Workup

  • Author: Naveenpal S Bhatti, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Jan 13, 2012
 

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.
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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. See the images below. Anteroposterior view of the pelvis with a displaceAnteroposterior view of the pelvis with a displaced femoral neck fracture. Lateral view of a displaced femoral neck fracture.Lateral view of a displaced femoral neck fracture.
  • 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.
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Contributor Information and Disclosures
Author

Naveenpal S Bhatti, MD  Attending Physician, Department of Emergency Medicine, Washington Hospital, Fremont, California

Naveenpal S Bhatti, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Janos P Ertl, MD  Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerard A Malanga, MD  Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Cephalon Honoraria Speaking and teaching; Endo Honoraria Speaking and teaching; Genzyme Honoraria Speaking and teaching; Prostakan Honoraria Speaking and teaching; Pfizer Consulting fee Speaking and teaching

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

Henry T Goitz, MD  Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

References

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  15. 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].

 
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A subcapital femoral neck fracture. Slight compression of the femoral head onto the femoral neck can be seen. Note the cortical break medially. This fracture could be missed if not closely evaluated.
A view of the contralateral hip for comparison.
Intraoperative x-ray film (fluoroscopic view) of placement of the lag screw.
Addition of a superior derotational screw to maintain alignment and allow compression.
Internal fixation of the subcapital femoral neck fracture with a screw and short side plate with an additional derotational screw above. Final anteroposterior view.
Garden I femoral neck fracture. Note the valgus impaction with compression of the superior femoral head-neck junction.
Lateral view of a Garden I femoral neck fracture. Compression of the head-neck junction inferiorly.
Anteroposterior view of the pelvis with a displaced femoral neck fracture.
Lateral view of a displaced femoral neck fracture.
Displaced femoral neck fracture treated with a conventional, noncemented monopolar hemiarthroplasty.
Lateral view of a unipolar hemiarthroplasty.
An example of a calcar replacement hemiarthroplasty. A low femoral neck fracture extending into the calcar femoralis, not amenable to internal fixation or conventional hemiarthroplasty, requiring a calcar replacement prosthesis.
A lateral x-ray film of a calcar replacement hemiarthroplasty.
 
 
 
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