Hidden Hip Fractures

​An elderly woman arrived via ambulance at the emergency department after being knocked to the ground. Right hip pain prevented her from getting up. She had bilateral hip replacements, and was concerned that the right one could have come out of place. The area she indicated didn't seem dislocated. There was range or motion of the hip, and the leg was not shortened. Certainly, x-rays would confirm this.​The prostheses were intact. She had neither a hip fracture nor a dislocation. The patient still complained of pain, and was unable to ambulate. On closer inspection, the right superior pubic rami's inferior aspect had a cortical break. It certainly looked different from the other side.​CT actually confirmed two fractures of the superior rami.These fractures are managed nonsurgically, but pubic ramus fractures do not bode well for patients. The reason for this is not clear and likely multifactorial. A study by Hill, et al., found that 13.3 percent of patients who had a fracture of a public ramus died within a year, and 54.4 percent died within five years. (J Bone Joint Surg Br 2001;83[8]:1141.) Certainly, the fracture causes few of these deaths directly. A pubic ramus facture, however, may indicate a frailty, putting the patient at risk. The study also found that simple falls were the most common cause and accounted for 87.4 percent of the fractures.Tip to Remember: All that hurts in the hip are not proximal femur fractures. Always look at the pubic ring.​Tags: h...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs