General Guideline Principles for Hip Fractures
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Hip Fractures.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Overview of Hip Fractures

Frank and stress fractures of the hip are both types of fractures. Accidents involving vehicles or falls are the most common causes of occupational fractures.
The most frequent causes of stress fractures are repeated applications of unusual force over a brief period of hours to days.

Observation and the removal of the problematic exposure are typically used to treat these. Reducing stresses on the affected site could be helped by physical therapy to address movement system deficits, such as poor muscle function and motor patterns.

Related Terms

• Stress Fracture

   

• Hip Fracture

   

• Femoral Fracture

   

• Femoral Neck Fracture

   

• Intracapsular Fracture

   

• Intertrochanteric Fracture

   

• Subtrochanteric Fracture

   

• Acetabular Fracture

Initial Assessment of Hip Fractures

The initial assessment of a patient with a probable occupational hip fracture is typically simple because the patient’s history, the mechanism of the injury, and the incapacity to utilise the hip all offer compelling diagnostic information. It is vital to review the systems that also affect the knee, spine, abdomen, and genitourinary tract.

Diagnostic Criteria of Hip Fractures

The evaluation criteria for typical occupational hip fractures are summarised in the list of criteria that follows.

Diagnostic Criteria for Non-red-flag Conditions

1. Diagnostic Studies of Hip Fractures for Bone Scan

   Bone Scan is recommended may help in the diagnosis of certain patients with acute, subacute, or chronic hip pain

   Indications: Patients with suspected osteonecrosis, Paget’s disease, tumour, or other elevated polyostotic bone metabolism in addition to hip fractures.

   Frequency/Dose/Duration: single scan Rarely, a second scan may be necessary after at least three months have passed and there has been a clinically significant change in the symptoms and signs that results in a significant shift in the diagnosis.

   Rationale: To assess trauma, bone scanning may be a useful diagnostic procedure (e.g., occult fractures). In general, bone scanning is not recommended for the evaluation of hip OA. There is no need for bone scanning in patients whose diagnosis is believed to be certain because it does not affect management or treatment.

    

2. Computerised Tomography (CT)

   Computerised Tomography (CT) is recommended for assessing patients with hip fractures who are at risk for osteonecrosis, especially after traumatic dislocations or recurrent dislocations brought on by arthroplasty. Besides, CT for patients who require advanced imaging, but have MRI disqualifications.

   Indications: Patients with hip fractures who are experiencing osteonecrosis-related pain and who may also have subchondral fractures, enhanced polyosthotic bone metabolism, or traumatic hip dislocations, especially when femoral head or acetabular fracture fragments are desired; repeated hip dislocations brought on by arthroplasty evaluate the anteversion (rotational alignment) of the patients with acetabular and femoral components; MRI contraindications.

   Frequency/Dose/Duration: One evaluation. A second evaluation is rarely needed.

   Rationale: When sophisticated imaging of calcified bones is needed for the majority of hip problems, computerised tomography is thought to be preferable to MRI.

    

3. Helical CT Scan

   Helical CT Scan is recommended for a specific group of patients with hip fractures suspected to develop osteonecrosis or in need of advanced bone imaging but with MRI contraindications (implanted hardware).

   Indications: Patients with hip fractures who may have osteonecrosis or who require advanced bone imaging but for whom MRI is not appropriate. Helical CT often expedites scanning time, eliminates motion artefact, and is good for vascular problems.

   Frequency/Dose/Duration: one assessment Rarely is a second evaluation necessary.

   Rationale: MRI has substantially taken the place of helical CT scanning. However, it is believed to be more accurate than MRI when assessing subchondral fractures. Additionally, some patients (such as those with implanted ferrous metal hardware) are contraindicated for MRI; in these cases, helical CT is recommended for patients who need to have their AVN evaluated.ended.

    

4. Magnetic Resonance Imaging (MRI)

   Magnetic Resonance Imaging (MRI) is recommended for a small group of patients with hip fractures who also experience subacute or persistent hip pain, taking into account any associated soft tissue pathology or other diagnostic worries.

   Indications: Patients with hip pain that is subacute or chronic who require imaging of the surrounding soft tissues, including assessing any periarticular masses or structures (normally not recommended for hip pain that is acute as radiographs typically suffice).

   Frequency/Dose/Duration: Typically, just one test should be necessary. Rarely is a second evaluation necessary.

   Rationale: For examinations of patients with symptoms longer than three months, MRI has been recommended.

    

5. Radiographs

   Radiographs are recommended to assess hip fractures.

   Indications: all patients who could suffer a hip fracture. Additionally, if there are no warning signs but you have moderate to severe hip discomfort that lasts for at least a few weeks and/or restricted range of motion.

   Frequency/Dose/Duration: Typically, one set of x-rays is enough. It might make sense to have a second series of x-rays for individuals with persistent or worsening hip pain, especially if their symptoms alter.

    

6. Ultrasound

   Ultrasound of Hip Fractures is not recommended for assessing individuals with hip fractures. There is support for using ultrasound (US) to assess individuals with hip fractures.

Medications of Hip Fractures

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs.

There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.

1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs)

   Non-Steroidal Anti-inflammatory Drugs (NSAIDs) is recommended for the purpose of treating hip fracture-related pain.

   Indications: For treatment of pain associated with hip fractures, NSAIDs are recommended for treatment. Over-the-counter (OTC) agents may suffice and should be tried first.

   Frequency/Duration: As needed use may be reasonable for

   many patients.

   Indications for Discontinuation – Pain relief, ineffectiveness, or the emergence of side effects that need stopping.

    

2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors are commonly used together by individuals who are at high risk for gastrointestinal bleeding.

   Frequency/Dose/Duration – H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

   Indications for Discontinuation – Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

    

3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

   NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended As far as cardiovascular side effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options. If necessary, non-selective NSAIDs are recommended to COX-2-specific medications.

   To reduce the chance that an NSAID will negate the therapeutic benefits of low-dose aspirin in patients receiving it for the prevention of primary or secondary cardiovascular disease, the NSAID should be given at least 30 minutes after or eight hours before the daily aspirin.

    

4. Acetaminophen

   Acetaminophen for Treatment of Hip Pain is recommended for the treatment of hip fracture pain, especially in patients who are contraindicated for NSAIDs.

   Indications: Acute, subacute, chronic, and post-operative hip fracture pain in all individuals.

   Dose/Frequency: As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of liver toxicity.

   Indications for Discontinuation: pain, side effects, or intolerance are gone.

    

5. Bisphosphonates

   Bisphosphonates of Hip Fractures is recommended for selected patients with hip fractures brought on by osteopenia.

   Indications: Patients with hip fractures believed to be the result of osteoporosis or osteopenia should be monitored to avoid further fractures. Increased bone mineral density is a benefit. lower possibility of secondary fractures.

   Frequency/Dose/Duration: As per manufacturer Recommendations.

    

6. Calcitonin

   Calcitonin is not recommended for hip fracture patients.

    

7. Opioids

   Opioids of Hip Fractures is recommended for the management of a subset of patients with hip fractures after surgery

   Indications – A brief opioid course of a few days to no more than one week is advised for the treatment of post-operative hip fractures. Following surgery, a small nocturnal dose of opioids may be beneficial.

   Opioids are not advised for people with other types of hip fractures. Prior to using opioids, the majority of patients should try NSAIDs and acetaminophen for pain relief. It is advised to stop using opioids as soon as possible.

   Frequency/Dose/Duration – For the majority of hip surgeries, patients typically only need a few days to a week of opioid medication.

   Indications for Discontinuation – Hip fracture pain has subsided, the pain is adequately controlled by other medications, the medication is ineffective, or there have been side effects that require stopping.

Treatments of Hip Fractures

1. Hot and Cold Therapies Cryotherapy for Acute, Subacute, Chronic, or Post-operative Hip Pain

   Hot and Cold Therapies Cryotherapy for Acute, Subacute, Chronic, or Post-operative Hip Pain are recommended for hip pain that is immediate, ongoing, chronic, or post-operative.

   Indications – All patients with hip pain.

   Frequency/Duration – As many as three to five self-applications every day.

   Indications for Discontinuation – Resolution, negative consequences, and noncompliance.

    

2. Heat Therapy for Acute, Subacute, Chronic, or Post-operative Hip Pain

   Heat Therapy for Acute, Subacute, Chronic, or Post-operative Hip Pain are recommended for hip pain that is immediate, ongoing, chronic, or post-operative.

   Indications – All patients with hip pain.

   Frequency/Duration – Approximately three to five self-applications per day as needed.

   Indications for Discontinuation – Resolution, negative consequences, and noncompliance.

Surgery of Hip Fractures

1. Surgery of Surgical Intervention for Hip Fracture

   Surgery of Surgical Intervention for Hip Fracture is recommended as soon as the patient is medically stable.

   Indications: Hip fractures.

   Rationale: The surgical procedures and fixing materials employed vary greatly. The treating surgeon determines the kind of surgical procedure (such as a pin, screw, or nail) or non-operative care.

    

2. Arthroplasty for Hip Fractures

   Arthroplasty for Hip Fractures is recommended especially for patients with subcapital fractures and displaced femoral necks.

    

3. Hemiarthroplasty

   Hemiarthroplasty of Hip Fractures is recommended for patients with subcapital fractures and displaced femoral neck.

   Indications: hip fractures, particularly subcapital and displaced femoral neck fractures.

    

4. Systemic Antibiotics

   Systemic Antibiotics is recommended for people having hip surgery; usually used for one day. For patients having hip surgery, particularly those who have prosthetics.

   Indications: Systemic prophylactic antibiotics are widely used and are regarded as essential. Benefits: Lower chance of infection in joints or prosthetics.

   Systemic Antibiotics is recommended for the treatment of skin infections (post operative complications).

   Indications: For the treatment of recurring infections and postoperative problems

    

5. Treatment of Infected Prosthesis

   Treatment of Infected Prosthesis of Hip Fractures is recommended A dangerous result that typically necessitates surgical debridement, drainage, and the right medicines is an infected prosthesis. The removal of implanted hardware may also be necessary as part of the treatment, which typically entails lengthy IV antibiotics.

    

6. Treatment of Dislocations

   Treatment of Dislocations is recommended Referrals back to the treating surgeon should be made when necessary to lessen dislocation and the likelihood of recurrence.

Other of Hip Fractures

Acupuncture of Hip Fractures

Acupuncture of Hip Fractures is recommended following hip replacement surgeries.

Indications: Hip replacement patients.

Frequency/Dose/Duration: three postoperative days maximum.

Rationale: Acupuncture is effective for individuals who have had hip arthroplasty, as shown by two high-quality trials. This has helped to lower opioid requirements.

What our office can do if you have a Hip Fracture

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

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