← Diagnosis and Management Guides
Hip Fracture
Key considerations: Pathologic fracture, Open fracture, Vascular injury
Cannot miss
- Pathologic fracture
- Open fracture
- Vascular injury
Likely diagnoses
- Femoral neck fracture
- Intertrochanteric fracture
- Pelvic fracture
- Hip contusion/bursitis
Red flags
- Hemodynamic instability
- Open fracture
- Neurovascular compromise
- Anticoagulant use
Workup
- history: Mechanism (fall vs spontaneous), anticoagulant use, ambulatory status; exam: Shortened and externally rotated leg, pain with logroll, NV exam; labs: CBC, BMP, coags, type and screen, pre-op labs; imaging: AP pelvis and cross-table lateral hip XR; MRI if XR negative but high clinical suspicion; bedside: Neurovascular exam distal to fracture
Management
- immediate: Pain management (fascia iliaca block is excellent); IV fluids, pre-op optimization; general: Surgical fixation within 24-48 hours (reduces mortality); VTE prophylaxis; Medical co-management for comorbidities; PT/OT early mobilization
Disposition
- admit: All hip fractures; discharge: After surgical repair and functional rehab assessment; consults: Orthopedic surgery, medicine for co-management, geriatrics
Clinical pearls
- Delay in surgery beyond 48 hours increases mortality, pneumonia, and pressure ulcers
- Fascia iliaca block provides excellent analgesia and reduces opioid requirements
Source and review
- AAOS Hip Fracture Guidelines 2021. Last reviewed: 2024-11-01