Ortho Case of the Week – Hip and Femur ANSWERS
Break a leg!
Case 1: An 84-year-old female BIBEMS after a mechanical fall with left hip pain. On exam, her left leg is shortened and held in external rotation. Below is the pelvis x-ray you get in the trauma bay.
1. Name the different anatomic sites of the femur fractures on the diagram below.
2. What kind of fracture does she have?
Source: JETem
Acute comminuted displaced intertrochanteric fracture (red arrows) of left femur with varus angulation (green lines) and no dislocation. Greater (purple arrow) and lesser (yellow arrow) trochanters are annotated for reference.
Case 2: 31-year-old male BIBEMS after MCC at highway speeds with gross deformity and extreme pain to his left thigh. You obtain an x-ray of his femur in the trauma bay, below.
AP and lateral radiographs of the thigh showing displaced oblique femoral mid-shaft fracture.
1. In what injury or clinical scenario would you apply a traction splint?
Midshaft femur fractures. Contraindications include foot and ankle fractures given the need for distal strap placement.
2. How do you correctly apply a traction splint?
Unsure? watch this video: https://www.youtube.com/watch?v=s9gJ9QBEA88
Per the cited EMS Traction Spint Stat Pearls article by Davis, et al.:
- Stabilize the injured leg.
- Position the splint against the uninjured leg to adjust the length.
- Place splint under the patient’s leg and place the ischial pad against the ischial tuberosity.
- Adjust splint to length, then attach ischial strap over the groin and thigh.
- Apply the ankle hitch to the patient.
- Apply gentle but firm traction until the injured leg length is approximately equal to the uninjured leg length.
- Secure the remaining velcro straps around the leg.
- Reassess neurovascular function.
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