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Clinical features
- Inability to weight bear
- Shortened and externally rotated leg
- Straight leg raise and hip movements globally inhibited by pain
Investigations
- Plan film x-ray- If plain films are negative, but a fracture is still suspected then further imaging is required. Grounds for suspicion may include:
- patient unable to weight bear
- high-risk mechanism
- severe osteoporosis
- MRI is the investigation of choice. If unavailable, CT scan may be an option
- blood for U&E, glucose, FBC, and cross-match.
- Obtain an ECG to look for arrhythmias/MI and consider the need for CXR.
- Arrange other investigations as indicated by history/examination
Management
- Obtain IV access- Administer IV analgesia — give small increments of opioid (with an
anti-emetic) until the pain is controlled - Start IV fluids if indicated
- Consider adding nerve blocks/prepare splint and immobilize in Thomas
- Optimize medical comorbidities
- Admit to the orthopedic ward within two hours of their arrival to the ED
Complications
- Avascular necrosis of the femoral head (intracapsular > extracapsular)
- Neurovascular damage
- Dislocation of arthroplasty
- Non-union
- Compartment syndrome
- Venous thromboembolism
- Infection
- Haematoma
- Post-traumatic arthritis and chronic pain
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