Acute Pelvis & Hip Trauma Imaging Diagnosis Part II | El Paso, TX.

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Hip Fractures

 

 

  • Garden Classification (above) helps with Dx and correct management of patients
  • M/C Fx are subcapital (80%)
  • Fxs differentiated as intra-capsular (high risk of AVN) & extra-capsular (lower risk of AVN)
  • Garden 1: incomplete undisplaced Fx typically impaction with valgus off-set of the head (15-20% AVN) patient able to ambulate
  • Garden 2: complete, undisplaced Fx (30% AVN)
  • Garden 3: complete, partially <50% displaced
  • Garden 4: complete, 100% displaced Fx, pt collapsed with entire LE in ER (below image)
  • Most osteoporotic Fx are intracapsular

 

Complete Displaced Femoral Neck Fracture Clinical Presentation

 

 

 

Imaging: Begins with X-radiography with Most Fxs

 

  • CT scanning may help with further delineation of Fx complexity/displacement and Dx of additional regional Fxs
  • MRI can be helpful if x-radiography fails to Dx fx
  • X-radiography pitfalls: some undisplaced Garden 1 & 2 Fxs may be missed d/t pre-existing DJD and osteophytes along the femoral head-neck junction that may overly the Fx line
  • Fx line is incomplete and too small/subtle especially if the study is read by non-radiologists
  • Incomplete Fxs if left untreated will not heal and likely to progress to complete Fxs

 

 

  • AP hip spot view: note valgus deformity of the head (above yellow arrow) with a small/subtle line of sclerosis in the sub-capital region representing Garden 1 Fx. MRI may help with Dx of subtle radiographic Fxs. If MRI contraindicated, Tc 99 radionuclide bone scan may help demonstrate high uptake of the radiopharmaceutical in Fx (below image)

 

 

Above – Tc99 Radionuclide Bone Scan Reveals Left Subcapital Femoral Neck Fx

 

 

  • Garden 2 complete undisplaced (above green arrows) Fx

 

 

  • AP hip: Garden 3 complete partially displaced Fx (above the first image)
  • AP pelvis: complete displaced Garden 4 Fx (above the second image)
  • Clinical pearls: in some cases of Garden 4 Fx, DDx may be difficult to differentiate from OSP vs. pathologic fx d/t to bone Mets of Multiple myeloma (MM)
  • Management: depends on patients age and activity level
  • Garden 3 & 4� require total hip arthroplasty in patients <85-y.o.
  • Garden 1 & 2 may be treated with closed reduction of fx and open capsule and 3-cannulated fixating screws
  • Pre-existing DJD may require total arthroplasty
  • Occasionally observation may be performed on patients who are not active and significant risks of surgery and depends on surgical centers

 

 

  • m/c Rx of Garden 1 & 2 undisplaced Fx with 3-screws. Screws proximity depends on the bone quality and Fx type

 

 

  • THA aka hip replacement: cemented THA with bone cement (above the first image) vs. non-cemented (biologic) that is used mostly in younger patients
  • 2-types: metal on metal vs. metal on polyethylene
  • The femoral angle of the prosthesis should have slight valgus but never >140 degrees
  • The non-cemented component uses porous metal allowing the bone to integrate sometimes coating in bone cement from osteoconduction
  • THA has good outcome and prognosis
  • Occasionally cement failure, fractures, and infections may complicate this procedure

Supplemental Reading

 

Acute Pelvis & Hip Trauma

Dr. Alex Jimenez D.C.,C.C.S.T

Welcome-Bienvenido's to our blog. We focus on treating severe spinal disabilities and injuries. We also treat Sciatica, Neck and Back Pain, Whiplash, Headaches, Knee Injuries, Sport Injuries,�Dizziness, Poor Sleep, Arthritis. We use advanced proven therapies focused on optimal mobility, health, fitness, and structural conditioning. We use Individualized Diet Plans, Specialized Chiropractic Techniques, Mobility-Agility Training, Adapted Cross-Fit Protocols and the "PUSH System" to treat patients suffering from various injuries and health problems. If you would like to learn more about a Doctor of Chiropractic who uses advanced progressive techniques to facilitate complete physical health, please connect with me. We a focus on simplicity to help restore mobility and recovery. I'd love to see you. Connect!

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