Laboratory Studies
See the list below:
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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
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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
See the list below:
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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.
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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.
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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.
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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.
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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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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.
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A view of the contralateral hip for comparison.
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Intraoperative x-ray film (fluoroscopic view) of placement of the lag screw.
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Addition of a superior derotational screw to maintain alignment and allow compression.
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Internal fixation of the subcapital femoral neck fracture with a screw and short side plate with an additional derotational screw above. Final anteroposterior view.
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Garden I femoral neck fracture. Note the valgus impaction with compression of the superior femoral head-neck junction.
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Lateral view of a Garden I femoral neck fracture. Compression of the head-neck junction inferiorly.
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Anteroposterior view of the pelvis with a displaced femoral neck fracture.
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Lateral view of a displaced femoral neck fracture.
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Displaced femoral neck fracture treated with a conventional, noncemented monopolar hemiarthroplasty.
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Lateral view of a unipolar hemiarthroplasty.
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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.
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A lateral x-ray film of a calcar replacement hemiarthroplasty.
