Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Hip Fracture

—

In one line

·A fall breaks the top of the thigh bone where it meets the hip, especially in older adults with thin bones.

—

Normal physiology

·The hip joint is where the round top of the thigh bone (the femoral head) fits into a cup-shaped socket in the pelvis (the acetabulum). This ball-and-socket joint carries the full weight of your body when you stand, walk, or climb. The femoral neck—the narrow part of bone just below the ball—connects the head to the main shaft of the thigh bone. Strong, dense bone and healthy cartilage keep the joint stable and pain-free.

—

What goes wrong

·The bone at the top of the thigh gets thin and weak over time (osteoporosis), so even a simple fall from standing can snap the femoral neck or the area just below it. Once broken, the bone cannot hold weight, blood vessels tear, and the leg twists out of place.

—

Hallmark signs

·Sharp pain in the hip or groin that gets worse when you try to move your leg or put weight on it
·The injured leg looks shorter than the other leg
·The injured leg is turned outward so the foot and knee point away from the body
·Cannot lift the leg off the bed or stand on it at all
·Swelling and bruising spreading over the hip, thigh, or groin
·Tenderness when you press on the hip or groin area
·Hip or groin pain that started after a fall, even if the leg still moves a little
·Sudden confusion or worsening mental fog in an older adult after the injury

—

Red flags · escalate now

·Leg is cold, pale, or has no pulse below the hip (artery may be torn or pinched by the broken bone)
·Cannot feel or move the foot or toes (nerve damage from the fracture)
·Sudden chest pain or trouble breathing after the injury (fat or a clot from the fracture site may have traveled to the lungs)
·Signs of shock: fast heart rate, sweaty skin, confusion, or very low blood pressure (hidden bleeding inside the hip can be large and life-threatening)
·Fever, chills, or a wound over the hip (open fracture with bone poking through the skin risks serious infection)

—

Workup

—

Treatment

·Surgery within 48 hours (internal fixation with screws or a sliding hip screw for younger patients and stable fractures; partial or total hip replacement for displaced femoral neck fractures in older adults)
·Blood clot prevention with pharmacologic anticoagulation (low-molecular-weight heparin such as enoxaparin 40 mg subcutaneous daily, or fondaparinux 2.5 mg subcutaneous daily) AND/OR mechanical prevention (prophylaxis) (intermittent pneumatic compression devices)
·Multimodal pain control (regional nerve block such as fascia iliaca block or femoral nerve block; scheduled acetaminophen up to 3 g/day; NSAIDs if kidneys allow; short-acting opioids only for breakthrough pain)
·Early mobilization and physical therapy starting within 24 hours after surgery
·Delirium prevention bundle (reorient frequently to time and place; restore normal sleep–wake cycle; avoid sedating drugs like benzodiazepines and diphenhydramine; correct low oxygen, dehydration, constipation, and electrolyte imbalances; ensure glasses and hearing aids are in place)
·Bone health evaluation and treatment (DEXA scan to measure bone density; vitamin D 800–1000 IU daily plus calcium 1200 mg daily; bisphosphonate such as alendronate 70 mg weekly or zoledronic acid 5 mg IV yearly if osteoporosis is confirmed [T-score ≤ –2.5])

—

NCLEX trap

·Hip fracture needs X-ray right away and surgery within 48 hours. Waiting lets blood clots grow, confusion worsen, and the person get weaker. Do not delay.
·Confusion in hip fracture comes from pain, fear, blood flow changes, and staying still too long. Move the person early, reduce strong drugs, and check for blood clots and low oxygen. Surgery within 48 hours stops confusion better than medicine alone.
·If X-ray is clear but the doctor thinks hip fracture is there based on exam and story, get CT or MRI. Do not send the person home without imaging proof or surgery. A missed hip fracture leads to blood clots and death.
·Hip fracture causes blood clots in the legs in 5 to 10 days if the person stays still. Check the calves every shift. Swelling or warmth means clot risk is high—tell the doctor and use blood thinner medicine.
·Surgery within 48 hours is the rule, but the patient's breathing, heart, and kidneys must be stable first. Make the patient safe and ready for surgery—then do it within 48 hours. If the patient will die in surgery, talk with the family about goals and comfort care.
·Move the patient early and often after surgery. Staying in bed causes blood clots, confusion, skin sores, and weak muscles. Physical therapy and walking (with help) are part of the cure, not the danger.

—

Install Maldek by Hill as an app — studies work even offline