Materiały źródłowe

• #1 Hip fracture – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hip-fracture/diagnosis-treatment/drc-20373472

  A health care provider can often diagnose a hip fracture based on symptoms and the abnormal position of the hip and leg. An X-ray usually will confirm the fracture and show where the fracture is. […] If your X-ray doesn’t show a fracture but you still have hip pain, your provider might order an MRI or bone scan to look for a hairline fracture.

• #1 Hip Fracture: Diagnosis, Treatment, and Secondary Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0615/p945.html

  Hip fractures cause significant morbidity and are associated with increased mortality. […] Patients with hip fractures have pain in the groin and are unable to bear weight on the affected extremity. […] Plain radiography with cross-table lateral view of the hip and anteroposterior view of the pelvis usually confirms the diagnosis. […] If an occult hip fracture is suspected and plain radiography is normal, magnetic resonance imaging should be ordered. […] The family physician’s role involves multiple objectives: identify patients at increased risk of a hip fracture, promptly diagnose a hip fracture, facilitate long-term rehabilitation, reduce the risk of another hip fracture, and manage comorbid conditions. […] Plain radiography should be the initial diagnostic test in patients with suspected hip fracture.

• #2 Hip Fracture: Diagnosis, Treatment, and Secondary Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0615/p945.html

  Hip fractures cause significant morbidity and are associated with increased mortality. […] Patients with hip fractures have pain in the groin and are unable to bear weight on the affected extremity. […] Plain radiography with cross-table lateral view of the hip and anteroposterior view of the pelvis usually confirms the diagnosis. […] If an occult hip fracture is suspected and plain radiography is normal, magnetic resonance imaging should be ordered. […] The family physician’s role involves multiple objectives: identify patients at increased risk of a hip fracture, promptly diagnose a hip fracture, facilitate long-term rehabilitation, reduce the risk of another hip fracture, and manage comorbid conditions. […] Plain radiography should be the initial diagnostic test in patients with suspected hip fracture.

• #2 Hip Fractures: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36521464/

  Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. […] Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. […] Hip Fractures* / diagnosis

• #3 Hip Fracture: Diagnosis, Treatment, and Secondary Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0615/p945.html

  If radiography is negative and a hip fracture is still suspected, magnetic resonance imaging or a bone scan should be performed. […] When an older person presents with hip pain after a fall, he or she should be treated as if a hip fracture has occurred, until proven otherwise. […] A stress fracture or a nondisplaced fracture may have no obvious deformity. However, most patients have some fracture displacement. […] Pain is elicited with rotation, such as with the log roll maneuver, which involves gentle internal and external rotation of the lower leg and thigh in the supine position. […] Plain radiography is the initial diagnostic test for hip fracture. […] The frog-leg view should be avoided; positioning the limb for this view results in severe pain and can cause displacement of a nondisplaced fracture or worsen a displaced fracture.

• #3 Hip Fracture Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/87043-workup

  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. […] 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. […] 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.

• #4 Hip Fractures: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/hip-fractures.html

  Hip fractures present with anterior groin pain, inability to bear weight, or a shortened, abducted, externally rotated limb. […] Plain radiography is usually sufficient for diagnosis, but magnetic resonance imaging should be obtained if suspicion of fracture persists despite normal radiography. […] Cross-table lateral hip and anteroposterior pelvis radiography are the initial diagnostic tests for hip fracture. […] Magnetic resonance imaging is reserved for continued suspicion of fracture despite negative plain radiography. […] Classification as intracapsular, extracapsular, displaced, or nondisplaced drives management. […] If femoral neck stress fracture is suspected, nonweight-bearing status and complete activity cessation are recommended while awaiting definitive imaging to reduce risk of conversion to complete fracture.

• #4 Hip Fracture Overview – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557514/

  Hip fractures are one of the most frequent fractures presenting to the emergency department and orthopedic trauma teams. The terms hip fracture and neck of femur fracture are used synonymously. Both terms describe a fracture of the proximal femur between the femoral head and 5 cm distal to the lesser trochanter. […] Most hip fractures can be diagnosed, or at least suspected, from history alone. Classically a fall leads to a painful hip with an associated inability to walk. […] The majority of hip fractures can be diagnosed on plain film radiographs. An anteroposterior view of the pelvis should be obtained along with a lateral view of the affected hip. Occult fractures are those that are not visible on x-ray and account for between 2% to 10% of hip fractures. MRI has demonstrated 100% sensitivity and 93% to 100% specificity at diagnosing occult hip fractures and is, therefore, the gold standard.

• #5

  https://www.ortho-teaching.feinberg.northwestern.edu/cases/pelvis-hip/case7/case61diagnosis.html

  Occult Hip Fracture Diagnosis. By definition, plain film radiographs are negative in occult hip fractures. The physician has several options. […] According to the majority of authors, MRI is the study of choice, with 100% sensitivity and specificity reported in prospective studies evaluating its use in diagnosing occult hip fractures. MRI also has the advantage of being able to detect alternative causes of hip pain. […] CT is a popular choice due to accessibility. Limitations of CT include that it can miss small impacted fractures or nondisplaced fractures that run parallel to the axial plane. […] Radionuclide bone scanning has reported sensitivity of 93% and specificity of 95%. However, scans may not be positive until 72 hours after injury.

• #6 Hip Fractures – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/hip-fractures/

  Surgical treatment is required to relieve the acute pain of the fracture and to allow the patient to get out of bed. Having surgery as soon as possible can lessen the risk of complications. […] Imaging studies will help confirm the diagnosis and provide more information about the fracture. […] Most hip fractures can be diagnosed with an X-ray. […] An MRI scan provides fine images of both soft tissue structures and bone. Because it is very sensitive, it can sometimes detect a small or incomplete fracture that cannot be seen on an X-ray. […] A CT scan will provide a detailed cross-sectional image of your hip. Your doctor may order a CT scan to learn more about your fracture.

• #7 Hip Fractures: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1200/hip-fractures.html

  When suspected, the first diagnostic test is plain radiography, which may show loss of cortical density, cortical thickening, or frank fracture. However, plain radiography may appear normal, and if femoral stress fracture is strongly suspected based on the patient’s symptoms and activity history, magnetic resonance imaging of the hip should be performed.

• #8 Hip Fracture Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/87043-workup

  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. […] MRI is able to show areas of decreased signal in the marrow of the involved bone soon after the injury. […] An associated hip effusion on MRI may suggest an evolving femoral neck stress fracture.

• #9 Hip Fracture Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/hip-fracture/diagnosis.html

  Doctors use X-rays to diagnose a broken hip. You may need another test if your doctor thinks that you have a fracture but can’t see it on an X-ray. […] You might have a test such as: […] An MRI, which gives better images of bones and soft tissues. […] A CT scan, another way of getting more detailed images. […] A bone scan, which involves injecting a dye, then taking images. It can show hairline fractures, where the bone is cracked but the pieces are still in place.

• #10 Broken Hip: Types, Causes, and Symptoms

  https://www.healthline.com/health/hip-fracture-surgeries

  A broken hip is a serious condition at any age. It almost always requires surgery. Complications associated with a broken hip can be life-threatening. […] Your doctor may notice the obvious signs of a broken hip, such as swelling, bruising, or deformity. However, to make a correct diagnosis, your doctor may order special tests to confirm the initial assessment. […] Imaging tests help your doctor locate fractures. The doctor may order X-rays to take pictures of your hip. If this imaging tool doesn’t reveal any fractures, they may use other methods, such as MRI or CT. […] MRI may show a break in your hip bone better than X-rays can. This imaging tool can produce many detailed pictures of the hip area. Your doctor can view these images on film or on a computer screen. CT is an imaging method that can produce pictures of your hip bone and the surrounding muscles, tissues, and fat.

• #11 Hip Fracture Diagnosis, Treatments & Recovery | Reno Orthopedic Center

  https://renoortho.com/specialties/center-for-fracture-trauma/hip-fracture/

  Hip fractures are generally treated with surgery. […] To diagnose a hip fracture, your doctor will use a physical examination and imaging tests. […] X-rays are used to evaluate the location and severity of the broken bone. […] If multiple cracks exist, a CT(Computed Tomography) scan is often ordered to help plan treatment and surgery. […] Sometimes an MRI is ordered for small fractures or to help diagnose stress fractures that do not show up on plain x-rays. […] The type of fracture determines the type of surgery that is required. […] Hip fractures that occur in the femoral neck may require surgery depending on the location of the break, whether the broken bones are out of place (displaced) and the severity of the fracture. […] Nondisplaced femoral neck fractures can be treated with 3 screws placed through small incisions.

• #12 Hip Fractures – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/fractures/hip-fractures

  Hip fractures may occur in the head, neck, or area between or below the trochanters (prominences) of the femur. […] Diagnosis is by radiographs or, if needed, MRI. […] Diagnosis of a suspected hip fracture begins with an anteroposterior pelvis radiograph and a cross-table lateral view. If a fracture is identified, radiographs of the entire femur should be done. […] If a fracture is not seen on radiographs but is still suspected clinically, MRI is the preferred next imaging study. MRI is more sensitive than CT, which can miss up to 30% of acute fractures. […] If circumstances suggest a hip fracture and patients cannot flex the entire lower limb against resistance with the knee extended, suspect an impacted fracture, even if patients have only mild pain and can walk. […] If a fracture is suspected based on clinical findings but is not seen on radiographs, obtain MRI.

• #13 Diagnosing Hip & Pelvic Fractures | NYU Langone Health

  https://nyulangone.org/conditions/hip-pelvic-fractures/diagnosis

  Orthopedic specialists at NYU Langone diagnose many types of fractures in the hip or pelvis. Using imaging tests, they can determine the location of a fracture, how many bones are affected, and whether an injury has damaged surrounding soft tissues, such as tendons, ligaments, blood vessels, or nerves. […] Our hip experts evaluate the affected hip or pelvic bone during a physical examination and confirm the diagnosis using imaging tests. […] X-ray images use electromagnetic radiation to reveal the location of a fractured bone in the hip or pelvis. […] Your doctor may order a CT scan to examine a fracture pattern or assess the extent of damage in the hip joint. […] If a doctor suspects a stress fracture in the hip or pelvis that cant be seen on an X-ray, or if symptoms suggest damage to ligaments, tendons, blood vessels, or nerves in addition to a fracture, your doctor may recommend an MRI. […] If you have pain and swelling that indicates a fracture but you cant have an MRI because you have a pacemaker or other implanted medical device, your doctor may recommend a bone scan.

• #14

  https://www.orthobullets.com/trauma/1038/intertrochanteric-fractures

  Intertrochanteric Fractures are common extracapsular fractures of the proximal femur at the level of the greater and lesser trochanter that are most commonly seen following ground-level falls in the elderly population. […] Diagnosis is made with orthogonal radiographs of the hip. MRI is most helpful to evaluate occult hip fractures. […] Imaging: Radiographs recommended views include AP pelvis, AP hip, cross table lateral, and full length femur. […] CT is indicated as a second line imaging to evaluate for occult fracture when there is no access or contraindication to MRI. […] MRI is indicated for occult hip fracture and isolated greater trochanteric fracture to evaluate for intertrochanteric extension. […] Bone scan is rarely used due to improved access to MRI and CT, and it has a false negative rate up to 72 hours from injury. […] Diagnosis accuracy for bone scan is variable with sensitivity up to 98%.

• #15 Types of Hip Fractures | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/hip-fracture/types.html

  The most common types of hip fractures are: […] Femoral neck fracture: A femoral neck fracture occurs one to two inches from the hip joint. […] Intertrochanteric hip fracture: An intertrochanteric hip fracture occurs three to four inches from the hip joint. […] Another type of fracture called a stress fracture of the hip may be harder to diagnose.

• #16 Broken Hip: Fractures of the Femur, Pelvis and Acetabulum

  https://www.hss.edu/condition-list_hip-pelvis-fractures.asp

  A fracture of the hip may occur at the top of the femur where it meets the pelvis, the acetabulum (the portion of the pelvis that connects to the femur to form the hip), or both. […] A hip fracture is a break in either the upper portion of the femur or of the pelvis. […] The term „broken hip” usually refers to a fracture of the ball side of the hip joint, that is, a break in the upper femur, generally in one of three areas: the femoral neck (just below the femoral head) called an intracapsular fracture (most common), immediately below the femoral neck called an intertrochanteric fracture, the upper femoral shaft below the femoral neck called a subtrochanteric fracture (least common). […] Femoral hip fractures can be treated relatively easily, with our without surgery, depending on the severity of the injury.

• #17 What Is A Stress Fracture Of The Hip?: Sports Medicine Oregon: Orthopedic Surgery

  https://www.sportsmedicineoregon.com/blog/what-is-a-stress-fracture-of-the-hip

  A stress fracture usually occurs when a bone is subjected to repetitive strain or impact. […] The diagnosis of a hip stress fracture will be confirmed by an X-ray, or, if the fracture is difficult to find, a bone scan or MRI. […] Pain in the hip or groin should not be ignored, especially if an individual is regularly engaged in rigorous physical activity. If the pain does not cease after rest, or pain reoccurs after putting weight or stress on the hip, it is time to consult an orthopedic physician.

• #18 Hip Fracture Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/87043-workup

  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. […] 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. […] 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.

• #19 Physical therapy in Fremont, Carbon, and Sweetwater Counties for Hip Pain – Fractures

  https://www.fremonttherapygroup.com/article.php?aid=324

  The diagnosis of a hip fracture usually occurs in the emergency room. The diagnosis begins with a history and physical examination. It is important that the doctor be advised of any other medical problems the patient has so that treatment of the hip fracture can be planned. Most of the information from the history and physical examination will be used to try to evaluate the overall physical condition of the patient. Tests such as chest X-rays, blood work, and electrocardiograms may be ordered to assess the patient’s overall condition. […] X-rays are typically used to determine if a hip fracture has occurred and, if so, what type of fracture it is. The orthopedic surgeon will use the X-rays to determine if a surgical procedure will be necessary and to decide what type of procedure to suggest.

• #20 Hip Fracture Program

  https://navicenthealth.org/service-center/orthopaedic-trauma-institute/hip-fracture-program

  A hip fracture is a serious fracture of the femur that occurs in the upper part of the bone inside or around the hip joint. […] Hip fractures are one of the most serious types of fractures because the mortality within one year of people who suffer hip fractures is around 30%. […] If the leg on that side appears shorter and rotated in an unnatural way, the doctor will order an x-ray to confirm the diagnosis of a hip fracture. […] An x-ray usually makes the diagnosis of a fracture obvious. If the fracture is not detected by x-rays, a CT or MRI can be administered. […] Before surgery can be performed, a full medical evaluation is carried out. […] Doctors always want to make sure that the patient is medically optimized for this surgery, as it is a major operation that is often performed on an elderly person, and needs to be completed as safely as possible.

• #21 The Consequence of Delayed Diagnosis of an Occult Hip Fracture

  https://www.jtraumainj.org/journal/view.php?doi=10.20408/jti.2015.28.3.91

  PURPOSE Occult hip fracture is not evident on radiographs and the diagnosis is often missed or delayed. This study was undertaken in order to identify the clinical characteristics and complications of patients with a delayed diagnosis of an occult hip fracture. […] RESULTS Non-delayed group included 43 patients (86%). In the remaining 7 patients (delayed group), the diagnosis was delayed by a mean of 9.6 days (range 3~19 days). Patients who were diagnosed with an occult fracture on the initial visit presented later than those with a delayed diagnosis (41/43 .vs. 3/7, p=0.002). […] CONCLUSION A delayed diagnosis of occult hip fractures was associated with increased rate of displacement and operation. In patients suspected of having occult hip fractures, additional studies should be recommended.

• #22 Understanding Hip Fractures: Diagnosis and Treatment – Sanara MedTech

  https://sanaramedtech.com/blog/understanding-hip-fractures-diagnosis-and-treatment/

  Hip fractures are common, especially in older adults, and require timely medical and surgical intervention. […] Hip fractures are a medical emergency, and delayed treatment can lead to severe consequences. […] The mortality after hip fracture in an elderly patient remains high. This ranges between 15% to 35% within the first year. […] Prompt surgical intervention, within 24 hours, reduces the risk of these complications and improves outcomes. […] Understanding the types of hip fractures and the various treatment options available is essential for guiding patients through their recovery. […] Treatment of hip fractures is influenced by the patients age, overall health, and the type of fracture. Surgery is the most common treatment for hip fractures to restore mobility, functional alignment, and reduce the risk of complications.

• #23 Hip Fracture: Diagnosis, Treatment, and Secondary Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0615/p945.html

  The consulting orthopedic surgeon determines the most appropriate surgical procedure. […] The timing of surgery may affect the eventual outcome. Early surgery (within 24 to 48 hours) is prudent. […] The presence of two of the following indicates a higher risk of bleeding: peritrochanteric fracture, initial hemoglobin level less than 12 g per dL (120 g per L), and age older than 75 years. […] Long-term care is essential to return the patient to the most functional state as soon as possible, ideally to prefracture level of activity.

• #24 Hip Fracture | PM&R KnowledgeNow

  https://now.aapmr.org/hip-fracture/

  It has also been shown that women with a hip fracture have a five-fold increase and men have about an eight-fold increase in relative likelihood of death within the first 3 months. […] Although the continuum of hip fracture rehabilitation can be undertaken by an Inpatient Rehabilitation Facility (IRF), sub-acute rehabilitation (also known as SNF, skilled nursing facility), home based rehabilitation to outpatient rehabilitation, there is strong evidence supporting the superiority of IRF-based rehabilitation. […] IRFs optimize hip fracture rehabilitation by a comprehensive team of physicians, nurses, physical occupational therapists, social and case workers. […] It has been shown that hip fracture patients undergoing rehabilitation in IRFs were more likely to be discharged home after rehabilitation than patients undergoing rehabilitation in SNFs.

• #25 Physical therapy in Fremont, Carbon, and Sweetwater Counties for Hip Pain – Fractures

  https://www.fremonttherapygroup.com/article.php?aid=324

  In a few cases, X-rays may not show the fracture. If the hip continues to hurt and the doctor is suspicious that a hip fracture is present, magnetic resonance imaging (MRI) may be suggested. The MRI scanner uses magnetic waves rather than radiation to take multiple pictures of the hip bones. The MRI machine is very sensitive and can show fractures that do not show up on regular X-rays. […] This test is done to be certain there is no fracture before allowing the patient to put weight on the leg. Walking on a fractured hip may cause the two sides of the fracture to displace, or move apart, so that they no longer line up correctly. A fracture that has not displaced is much easier to treat than one that has. A displaced fracture also increases the risk of damaging the blood supply to the femoral head, causing AVN (discussed earlier).

• #26 Hip Fracture (Broken Hip): Symptoms, Risks & Recovery

  https://my.clevelandclinic.org/health/diseases/17101-hip-fracture

  A healthcare provider will diagnose a broken hip with a physical exam and imaging tests. Providers in the emergency room might diagnose the fracture in the ER if you experience a severe fall or other trauma. […] Your provider will use at least one of the following types of imaging test to take pictures of your hip and the area around it: Hip X-ray, MRI (magnetic resonance imaging), CT scan (computed tomography scan). […] Almost everyone with a hip fracture needs surgery. Which type of surgery you’ll need depends on the fracture’s severity and type, and if you have any other injuries or health conditions. […] The two most common surgeries for hip fractures include: Hip replacement (hip arthroplasty): Adults older than 65 who experience a hip fracture usually need a hip replacement. You may need a total or partial replacement.

• #27 Hip Fracture (Broken Hip): Symptoms, Risks & Recovery

  https://my.clevelandclinic.org/health/diseases/17101-hip-fracture

  Open reduction and internal fixation (ORIF): Your surgeon will insert screws, pins or plates, or a metal rod into your femur to secure the pieces of your bone in place while they heal. […] Hip fracture surgery complications can include: Avascular necrosis: Avascular necrosis is bone death that happens when blood flow is cut off to a bone for too long. […] Nonunion: Your bone may not grow back together completely or at all. […] Malunion: This happens when a broken bone doesn’t line up correctly while it heals. […] Bone infection (osteomyelitis): If you have an open fracture (the bone breaks through your skin) you have an increased risk of bacterial infection. […] All hip fractures are medical emergencies. Call 911 (or your local emergency services number) if you think you have a broken hip. […] You can’t stand, walk or put weight on a broken hip. Putting pressure on your hip can make the fracture worse and cause other complications and injuries.

• #28 Hip Fracture | PM&R KnowledgeNow

  https://now.aapmr.org/hip-fracture/

  Hip fracture is one of the classic inpatient rehabilitation diagnoses: one of the 13 medical conditions that meet CMS compliance threshold. […] A hip fracture can be classified as either intra-capsular or extra-capsular. […] Imaging evaluation should begin with anterior-posterior (AP) image and a cross-table lateral projection of the hip. Three studies showed that a limited MRI of the hip could identify occult hip fractures. These data have led the current recommendations to be plain film radiography followed by MRI in patients older than the age of 50 years. […] Hip fractures are associated with significant morbidity and mortality, with mortality rates at 1 month post-operatively as high as 10%. […] Seniors with impaired ADLs prior to hip fracture had higher risk of ADL decline 6 months after surgery if they had sustained an intertrochanteric fracture vs femoral neck or sub-trochanteric fractures.

Zobacz więcej