# Hip Fractures



## skyemt (Dec 20, 2007)

Hi all...

our community has a fairly large elderly population, and as you can imagine, hip fractures are all too common...

i'd like to know, especially from the more experienced providers, what your preferred method of immobilization is...

pain management is also an issue, as i've heard blood curdling screams from pt's with hip fractures...

thanks


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## BossyCow (Dec 20, 2007)

Take a look at this.  I haven't actually seen one in use yet, just the promo literature, but looks wonderful to me.  

http://www.armstrongmedical.com/ami/item.cfm?sction=3&sbsection=19&itemid=2430

We have a gianormous vacu-splint which we have used to immobilize hip fractures.  Also in a pinch, a sheet can be tied firmly around the hip area and will work at least until you have them on top of of vacu-spint or other immobilization device.  Also seen mast pants used for hip fx immobilization.


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## KEVD18 (Dec 20, 2007)

"...allows for safe application at the scene by ordinary EMS personnel."

what exactly the hell is that supposed to mean


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## Ridryder911 (Dec 20, 2007)

One should recall the anatomy of what is really usually breaks in hip fractures. In most cases of hip fractures, the neck of the femur is the primary source, since it is the weakest point. 

I was taught by an orthopedic surgeon many years ago the reason of severe pain was the ability of the ball and the femur had the ability to shift around. 

I have found the Sam splint very helpful in those involve more a pelvic or acetabulam (cup portion that the ball fits into). One can make an improvised one with a towel rolled and placed under the ischium of the upper thigh, and a sheet (folded into length) and tied around the waist firmly. Decreasing the proximal end is the main goal. 

For pain management, I prefer Toradol, low dose Morphine, Demerol, or Fentyl. One has to be cautious that a pelvic fracture is not involved as well. Remember, pelvic fractures usually occurs in "two's". 

R/r 911


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## emtangie850 (Dec 20, 2007)

Depending on the size of the patient you could use a KED.. (Obviously use it around the hip instead of being used for spinal immobilization.)

Havn't done it myself but heard about it in my EMT class a few years ago.

-Angie


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## rescuepoppy (Dec 22, 2007)

*Hip Fracture*

An inverted XP-1 works great to stabilize a hip fracture.


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## medic001918 (Dec 23, 2007)

emtangie850 said:


> Depending on the size of the patient you could use a KED.. (Obviously use it around the hip instead of being used for spinal immobilization.)
> 
> Havn't done it myself but heard about it in my EMT class a few years ago.
> 
> -Angie



I use a KED often for hip fractures with great results.  It provides a good support for the injury while allowing for a decent way to grab the patient.  It's my preferred method for these calls actually.

Shane
NREMT-P


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## Moshi (Aug 4, 2012)

I'm sorry to bump this old topic but can someone show me an example of how exactly do you immobilize hip fracture with KED?


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## leoemt (Aug 4, 2012)

Moshi said:


> I'm sorry to bump this old topic but can someone show me an example of how exactly do you immobilize hip fracture with KED?



Turn the KED upside down.

A sheet slid under the patient and knoted works great, thats what we do around here. Even the hospitals do it. No special splints for us.


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## Tigger (Aug 5, 2012)

Also, don't forget about the scoop stretcher to move these patients from the ground and then to the hospital bed!


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## AnthonyM83 (Aug 5, 2012)

Hmmm. I had been trained only to do this for pelvic fractures, not for hip fractures


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## Thriceknight (Aug 5, 2012)

Our system has "full body vacuum splint" which work very nicely. We call it the burrito bag...though don't call it that in your PCR!!! I didn't do that....my partner did! Lol


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## Sandog (Aug 5, 2012)

AnthonyM83 said:


> Hmmm. I had been trained only to do this for pelvic fractures, not for hip fractures



No, it's twue, it's twue.
http://www.ems1.com/ems-products/patient-handling/tips/1112488-The-upside-down-KED/


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## Sandog (Aug 5, 2012)

I would be careful using the sheets though, too tight would cause excess flexion near the pelvic region creating real pain.


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## Jack Bode (Aug 5, 2012)

We don't "splint" hip fractures except to help stabilize the leg once the patient has been picked up and placed on the stretcher. We do offer pain relief with Morphine, 0.1 mg/kg, (can be repeated).


I work in an urban system with relatively short transport times. I suppose a case could be made for splinting for long transports in rural areas.


Otherwise, I see no reason to splint hip fractures.


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## Asclepius911 (Aug 5, 2012)

In theory the use of a pneumatic antishock garment is called for.. in actuality I've never seen one .. has anyone ever used that crazy looking sleeping bag?


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## FunkyAnesthetic (Aug 5, 2012)

*Pasg*

My EMT-B instructor told my class that the PASG is essentially worthless because in the time that it takes to put one on a patient, he could already have the pt at the hospital.  

Having never even seen one, I don't know if that's realistic, but the Trauma Manual 4e (written and reviewed by a bunch of surgeon's and M.D.'s) states that the, "current recommendations are for use in hypotension due to suspected pelvic fracture, otherwise uncontrollable lower extremity hemorrhage, and severe traumatic hypotension" (29).  FWIW, the book also suggests that in most urban settings, the short response times make the PASG less worthwhile.


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## Veneficus (Aug 5, 2012)

Asclepius911 said:


> In theory the use of a pneumatic antishock garment is called for.. in actuality I've never seen one .. has anyone ever used that crazy looking sleeping bag?



Of course i have.

I am a dinosaur...


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## mycrofft (Aug 5, 2012)

I was certified to use them in Nebraska, 1981.


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## NomadicMedic (Aug 5, 2012)

Used em once. Didn't help. :/


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## Bullets (Aug 5, 2012)

Does the ked manual indicate use for hip and pelvic fractures? What type of liability would you e exposed to using a device outside it's intended purpose


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## Veneficus (Aug 5, 2012)

Bullets said:


> Does the ked manual indicate use for hip and pelvic fractures? What type of liability would you e exposed to using a device outside it's intended purpose



Considering a pillow splint is useful in hip fractures?

Edit: and pelvic fractures are easily reduced with a bed sheet.


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## Akulahawk (Aug 5, 2012)

Asclepius911 said:


> In theory the use of a pneumatic antishock garment is called for.. in actuality I've never seen one .. has anyone ever used that crazy looking sleeping bag?


The PASG? I have seen it used...13 years ago... and nobody remembered how to take it off. I was certified how to put 'em on about 12 years ago. We were also told about how to remove them once they'd been put on. They weren't exactly in common use at that time anymore but we still had to learn how to work with them. :blink:


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## Moshi (Aug 6, 2012)

OK I get the instructions on how to do it but I would really appreciate a picture of it.
It's hard for me to visualize how it looks.


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## the_negro_puppy (Aug 6, 2012)

I often use the sheet splint trick or sometimes don't depending on the patient's level of comfort etc. I've been to some broken hips (neck of femur fractures :lol where the patient was virtually pain free except on movement. Splinting is probably a good idea considering how bumpy our van ambulances are.


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