Makindo Medical Notes.com

# Neck NB in young active patients this is a clinical emergency

Commonly a fall in the elderly – unable to weight bear. Leg may be shortened & externally rotated. Requires extreme violence in the young

Impacted # may be difficult to see on initial X-Rays.

Consider CT or if ongoing pain and/or struggling to mobilise.

Note: any patient who is discharged from ED or CDU after a hip injury with no fracture seen on X-ray requires a hip injury advice leaflet to return if problems.

Most require operative fixation. Utilise the #NOF pathway to expedite imaging, analgesia and transfer to trauma ward. Provide a fascia iliac nerve block with monitoring unless contraindicated

+ parenteral analgesia +/- iv fluids if any delay. Clerk on trauma proforma and complete mental health assessment in over 65s.

Immediate referral via ortho SHO and trauma coordinator. In patients under 65 prompt referral is vital. Provide patient info leaflet to all patients who are discharged home i.e. patients with no clear # on X-Ray and safe for discharge.

Hip dislocation

RTC or fall: Axial force along femur with hip flexed. Leg may be short, adducted externally rotated.

Acetabular fracture, knee or sciatic nerve injury. Be alert for other significant injury as requires extreme violence

Orthopaedic emergency: Will normally require emergency surgery within 6 hours.

Immediate emergency referral to ortho.

Dislocated THR

Internal/External rotation with hip flexed. Leg short and internally/externally rotated.

Recurrence.

Sciatic nerve injury: Note neurovascular status

Normally by ortho in theatre (always for 1^st dislocation) Consider in ED ONLY if GA& analgesia available. Trained personnel only and ED consultant

must approve.

Immediate referral to ortho

Slipped Upper Femoral Epiphysis (SUFE) in children

Occurs as a chronic problem or acutely as a Salter-Harris I #, often during sport.

Usually 8yrs or older

Request frog lateral view: May be missed on AP pelvis. Knee pain with a normal

knee examination may represent hip pathology.

Immediate referral for fixation

Immediate referral to ortho

Femoral Shaft

Any age. Usually significant force – often RTC or fall from a height. Consider non-accidental injury

in children

Common site for pathological #. Note neurovascular status: Arterial injury can occur. X- Ray whole femur to exclude hip #/dislocation/ knee injury

Kendrick splint, iv access and femoral nerve block (unless contraindicated) including children.

Immediate referral to ortho

Femoral condyles

High energy injury except in frail/elderly.

Above knee backslab. Usually require fixation. Undisplaced # may be treated NWB in AK POP

Immediate referral to ortho