EMERGENCY DEPARTMENT EVALUATION AND TREATMENT OF HIP AND THIGH INJURIES - 05/09/11

Doi : 10.1016/S0733-8627(05)70107-3

Nate Rudman, MD ^a, Daniel McIlmail, MD, MAJ, MC ^b

^a Department of Emergency Medicine, Cape Cod Hospital, Hyannis, Massachusetts (NR)

^b Madigan-University of Washington Emergency Medicine Residency Program, Tacoma, Washington (DM)

Résumé

The emergency physician (EP) commonly encounters injuries to the hip and thigh. The combination of an increasing life expectancy and the preponderance of high-velocity trauma in our society are the main causes. Hip fractures alone account for over 250,000 hospital visits in the United States annually,^{107 Zuckerman J.D. Hip fracture N Engl J Med 1996 ; 334 : 1519-1525 [cross-ref]

Cliquez ici pour aller à la section Références} almost twice the number reported in the 1960s.^{57 Kyle R., Cabanela M., Russell T. , et al. Fractures of the proximal part of the femur J Bone Joint Surg 1995 ; 76 : 924-948

Cliquez ici pour aller à la section Références} The incidence is expected to quadruple worldwide in the next 60 years.^{31 Dubey A., Koval K.J., Zuckerman J.D. Hip fracture prevention: A review Am J Orthop 1998 ; 27 : 407-412

Cliquez ici pour aller à la section Références} There is often significant morbidity and mortality associated with these injuries, with the 1-year mortality rate for elderly patients with hip fracture ranging from 14% to 36%.^{107 Zuckerman J.D. Hip fracture N Engl J Med 1996 ; 334 : 1519-1525 [cross-ref]

Cliquez ici pour aller à la section Références} The incidence of hip fractures and dislocations also is increasing among young patients who sustain high-energy trauma.^{28 DeLee J.C. Fractures and dislocations of the hip Fractures in Adults Philadelphia: Lippincott–Raven (1996).

Cliquez ici pour aller à la section Références} These patients often have other associated injuries, which can mask their orthopedic injuries. Most hip and thigh injuries are diagnosed easily on the basis of clinical findings and standard radiographs; however, some may be subtle, thus requiring a high degree of clinical suspicion. In addition to injuries to native bone and joints, the emergency physician is often required to evaluate the patient with postprosthetic implant complaints. This article focuses on the clinical and diagnostic evaluation of patients with injuries to the hip and thigh, with an emphasis on the history and physical examination, appropriate imaging strategies, complications and associated injuries, analgesia, treatment, and appropriate patient disposition.