II. Pathophysiology

  1. Images
    1. hipFractureRegions.jpg
  2. Extracapsular Hip Fracture
    1. Contrast with Femoral Neck Fracture
  3. Mechanism of injury
    1. High speed accident
    2. Fall from height

III. Diagnosis

  1. See Hip Fracture
  2. Fracture line between greater and lesser trochanters
    1. Above Subtrochanteric Fracture
    2. Below Femoral Neck Fracture

IV. Management

  1. See Hip Fracture
  2. Evaluate for associated injuries (see pitfalls below)
  3. Strongly consider regional Nerve Block (Fascia Iliaca Block or PENG Block) in hip and Femur Fractures
  4. Closely manage fluid status
    1. Initial Resuscitation with isotonic crystalloid
    2. Type and Cross for 2 Units pRBC
    3. Continually reassess hemodynamic status
  5. Open reduction and internal fixation
    1. Surgery within 48 hours of injury

V. Complications

  1. Significant blood loss and hemodynamic instability

VI. Pitfalls

  1. Elderly are often significantly dehydrated
  2. Associated injuries are common
    1. Distal Radius Fracture
    2. Proximal Humerus Fracture
    3. Rib Fracture
    4. Spinal compression Fractures (esp. T12 and L1)

VII. Prognosis

  1. High mortality in first year: Up to 30%

VIII. References

  1. Gurr in Marx (2002) Rosen's Emergency Med, p. 655-60

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