Intertrochanteric Hip Fractures Workup

Updated: Mar 23, 2023
  • Author: James F Kellam, MD, FRCSC, FACS, FRCS(Ire); Chief Editor: William L Jaffe, MD  more...
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Approach Considerations

The presence of coexisting medical conditions is determined by means of a complete physical examination; cardiac, laboratory, and pulmonary studies; and any other studies that may be indicated. Preoperative tests frequently include a complete blood count (CBC), urinalysis, an SMA-12 (sequential multiple analysis–12-channel biochemical profile), chest radiography, and electrocardiography (ECG).

Additional tests may be required, depending on the clinical findings, the past and current medical history, and the results of screening laboratory studies and imaging. Any medical abnormalities are treated promptly and appropriately before surgical intervention to ensure that complications do not occur because of any unnecessary delay in initiating surgery. Appropriate measures are instituted to decrease the possibility of deep vein thrombosis (DVT) and secondary pulmonary embolism (PE; usually considered a preoperative protocol).


Imaging Studies

Necessary radiographs of the hip include an anteroposterior (AP) view of the pelvis and the involved hip and either a cross-table lateral view or a frog lateral view of the hip. The pelvis radiograph is useful for preoperative planning, particularly to determine the neck shaft angles for placement of cephalomedullary nails.

In some cases, a frog lateral view, computed tomography (CT), or even a reconstituted CT scan of the hip may be necessary to define the fracture in sufficient detail to allow accurate planning of the surgical procedure.

A traction AP radiograph is helpful for further delineating the fracture pattern if significant displacement has occurred.