Hip Immobilization

[mikie]

How would you immobilize a hip fx? I have seen/heard of different methods, from a KED to a McGyver method of using a sheet and tearing it and somehow splinting the hip. I have also seen hip-immobilizers.

What are your thoughts?

Thanks!

I couldn't find a previous thread out there (using the search tool), so shoot up a link if this has already been discussed!

 

[mikeylikesit]

be careful with the straps on the LSB. i use a strip or a sheet with as much padding as possible for the comfort of the patient. i hate the prognosis of hip fractures though.

 

[Hastings]

PASG?

On a serious note though, in the field, truth is, we rarely do. Pain control, careful handling, shock control, transport.

 

[mycrofft]

Old m,ethod was pilllow betwen the thighs, padding outside, sheets to hold it.

The precise location of the fracture (does it include the acetabulum as in a fall to the feet, or strictly femoral neck due to a fall to the side or backwards?) makes some difference, but not too much in the field. Immob with comfort, prevent and anticipate shock, and deedee outta there. I find that cheap, pliable thin pillows can go a long way in splinting a lot of things if you aren't hung up on pre-hospital straightening.

(I notice my comments generally assume a near-urban setting. I wonder what our rural bretheren and sisteren have to say about any of this?)

 

[mikie]

And from what I remember from school, if a hip fx is suspected, you SHOULDN'T palpate/test/move (word choice?) it for stability as you usually would during the full-body physical assessment as it could cause more damage.

true?

 

[Buzz]

Anyone got a picture of the KED board method being used? I use the sheet method...

 

[akflightmedic]

Take the KED, turn it upside down and secure.

It immobilizes the hip wonderfully plus gives you two handles in a convenient spot to aid in gentle lifting.

 

[Tiberius]

The LSB can be used in conjunction with pillows, sheets, etc. placed between the voids. etc. and makes moving the pt. easier.

 

[fma08]

PASG?

On a serious note though, in the field, truth is, we rarely do. Pain control, careful handling, shock control, transport.

One of the few things I'd consider MAST pants for, but like Hastings said, if suspected it's more so very careful handling and pain control, keeping an eye out for internal bleeding/shock/CMS around here.

 

[Ridryder911]

And from what I remember from school, if a hip fx is suspected, you SHOULDN'T palpate/test/move (word choice?) it for stability as you usually would during the full-body physical assessment as it could cause more damage.

true?

One should not use excessive pressure or perform "rocking: when checking but one can push slightly down on both sides of the pelvis as well as from the lateral sides to illicit pain, or to detect crepitus.

Remember, there is NO such thing as a "single" pelvis fxr. Pelvis always break in bi-lateral segment. Now, hip fractures are NOT pelvis fractures, rather they are superior femur fractures of the surgical neck. Yes, one can have a (single) fracture pelvis at the acetabulum with the head of the femur is driven into the "cup" (the ring: ilium, ischium, and pubis) rather those are still considered more an isolated femur/pelvis and one still needs to check for bi-lateral involvement.

I was taught several years ago a different type of assessment for hip fractures by an orthopedic surgeon. I will place one hand on top of the anterior aspect and place slight firm pressure and then will reach under the hip itself and using my other hand push upward near the gluteal fold. One can illicit severe pain if it is fractured, if it is not usually it will not cause any difference. This happens because of the palpation is at the possible fxr site. While I have my hand in this position I will "roll" thin pillows or even towels under the hip at the site. Then wrap a sheet taught across the pelvis forming a "swathe" type splint.
Remembering the anatomy of the pelvic girdle, that the pain is usually produced from the surgical neck area of the femur moving from the head (still in the cup).

I have used the inverted KED; but found it to be to rigid and cumbersome for me but have seen it successful on some patients.

I have not got to use the new commercialized pelvis/hip wrap splint type devices. They look promising.

As well, I have found the scoop device a wonderful addition in lieu of a LSB. One can remove the scoop in the ED and decreased pain of laying onto a hard board is eliminated.

 

[Hoofguy]

Nice write up, that pretty much answered any questions I had.

 

[mycrofft]

Ridryder I hear you, thanks! Let me stray a moment.

I was doing medical case management for a couple years recently before I regained my senses, but it was educational and I was lucky enough to get "ortho", along with some other specialties. I was seeing some cases with a single type "hip area" fx, usually minor ones of the femoral neck, but virtually all involved younger individuals with moderate force mech of injury (i.e. falling down from no height onto the hip, at least per the pt, many were admittedly intoxicated at the time and may have bne density issues due to malnutrition). Oldsters and folks in car crashes etc, yeah, broken china syndrome. I think this is another example of where the hosp dx may differ, but since the more-common multi-fx situation is potentially more serious, they should all be addressed as thought the whole area's broken anyway, in the manner that you say. (I'd sure want it that way for me or mine!). Thanks!!
PS: kinda makes one question the anatomic usefulness of the "hip" concept outside swimsuit layouts. Femur, pelvis...no hip.

 

[mikie]

If someone has a picture of the KED being used, that would be great!

I'm just wondering, would using the KED in conjunction with the LSB cause any problems? I'm just picturing that with the KED in the hip/pelvic area it is going to become elevated (more so then the rest of the body) thus causing problems?

 

[mycrofft]

I notice the absence of the SAM sling..?

http://www.sammedical.com/sam_sling.html

 

[ffemt8978]

http://www.sammedical.com/sam_sling.html

I've used sheets, the inverted KED, and the Sam Slings. Each has their advantages and disadvantages, but our MPD has decided that the Sam Sling is what he wants us to use right now.

Sheets are cheap, and we carry lots of them on the ambulance. The disadvantage is that sometimes the knot can work it's way loose.

Inverted KED is something that is already on the rig, but like Rid said, it can be a little bulky and uncomfortable for some patients.

The Sam Slings are the medium priced option, and lock securely. The disadvantage is that you have to carry multiple sizes.

 

[mikie]

What is the sheet method? What kind of knots are needed?

 

[ride2k]

Upside down KED seems to work as if that was it's main purpous. It's a perfect fit for a hip.

 

[MSDeltaFlt]

What is the sheet method? What kind of knots are needed?

Simple square knot.

 

[Jon]

Oh... in case you wern't a Boy Scout (or Girl Scout), and you never learned the knot - here is the link on how to tie a square knot:
http://www.animatedknots.com/reefsc...ge=LogoGrog.jpg&Website=www.animatedknots.com
Little factoid - If you tie a bow knot correctly (like your shoelaces) and then pull out the bows to leave the knot... you will have a square knot.