Question about hip fractures.

[lolagurl]

Hi, I'm a recent nursing graduate waiting for my ATT to arrive. I'm currently working as an aide and have concerns about a pt.

Recently a pt. fell and fractured a hip, then a few days later fell again and dislocated the same hip. Pt. was sent to the hospital, treatment was a closed reduction. X-ray's verified correct placement. The patient's affected leg is at least one inch shorter than the other and complains of pain. He had minimal complaints of pain prior to second fall and was able to stand with little assistance. Now he is difficult to transfer even with the assist of two. I told the RN caring for him about my concerns and she looked at his leg. She said that it wasn't abnormally rotated and that the x-ray confirmed placement. I also asked my supervisor about the leg length discrepancy. She told me that most patients with hip fracture repairs will have leg lengths different from each other. I'm wondering if this is true. It seems to me that corrected alignment should make the legs equal lengths. Does anyone know about hip fracture repairs?

[locolorenzo22, BSN, RN]

I work as a CNA on a ortho floor...and therein lies the problem....

Without an actual replacement and correct spacing....the legs will probably be different lengths....not by much, but enough to make transfering difficult.

Also, closed reduction may have led to some bone on bone problems, and while the bones may be placed correctly...it's possible that it just doesn't line up quite right....hope that helps.

[lolagurl]

he had surgery after the first fall but I don't know if it was a total hip replacement or hemiarthroplasty. When he fell the second time the affected hip was dislocated. What I'm wondering is, following a hip surgery do most patients have equal or unequal leg lengths?

[Riseupandnurse]

Your patient needs another xray, maybe even a CT. This is not right. ---ortho nurse

[darius000]

I work in ED in Perth western Australia or ER as you know it. We often see post surg hip disclocations and do clesed reductions, prior to sending patients back to care facilities or on to the wards for management. By no means am I claiming to be an expert in ortho stuff, but my understanding is that after a closed reduction, the legs need to be immobilised in waht we call a "charnley pillow". This semi triangular pillow goes between the legs and both legs are strapped in to prevent too much movement of the newly re-located hip. I am not sure how long this should be insitu. But if your patient now has shortening and pain, my guess is that although the hip was ok on initial post reduction x-ray, then mayby it has moved or slipped out again.

I "googled" the following because I did not know that shortening post surgery was a possibility:

leg shortening post hip replacement

and found 200,000 hits, the first is here which explained a lot to me

http://www.medscape.com/viewarticle/421041

[lolagurl]

Well someone either listened to what I was saying or actually assessed him themselves. His x-ray showed a major dislocation. Taken to ER.

What I find surprising is that everyone kept saying, well the x-ray from the hospital showed it was in place. That x-ray was from when he fell, like a week ago. Anything could happen in that amount of time. I don't understand why no one wanted to go and actually assess him. It wasn't hard to tell that his knees didn't line up and one leg was shorter than the other.