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Lateral radiograph (x-ray) of hips
0%
0/21
Computed tomagraphy (CT) scan of his hips and lumbar area
5%
1/21
Anterior-posterior (AP) and lateral radiographs of hips, knees, lumbar, and cervical area
86%
18/21
Magnetic resonance imaging (MRI) of hips, knees, lumbar, and cervical area
AP and lateral radiographs of hips
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Although pain is only elicited from the hips, it is necessary to image suspected areas based on the mechanism of injury. As our patient appears to have landed on his feet, it is important to assess the integrity of his hips, knees, lumbar, and cervical area using AP and lateral x-ray's. Important rules to keep in mind when assessing impact trauma are to assess the joints above and below the fracture point using x-ray imaging. AP and lateral images are taken to appropriately evaluate the injury. Other bones should be assessed using imaging based on the line of impact and force. Unstable vitals may point towards internal hemorrhage, especially in the pelvis, and necessary intervention must be undertaken (i.e. hip binder, fluid resuscitation). Brunner et al. discuss presentation and treatment of hip fractures in adult populations. Clinical presentations include shortening of the limb and external rotation along with hip pain. It is possible to have vague nonlocalized pain around the knee, buttock or lumbar area. Even with unaltered ability to ambulate, clinicians should be wary of hip fracture based on patient's clinical history and pertinent physical exam clues. Burkhardt et al. discuss current trends in treatment of internal hemorrhage following pelvic fracture. Mortality from blood loss following pelvic fracture continues to be high. The most efficacious treatment modality is still a topic of debate among practitioners, with favorable interventions including arterial embolization, pelvic packing, and fluid resuscitation. The authors argue that restrained fluid volume therapy may result in a more favorable outcome in comparison to massive resuscitation protocols. Incorrect Answers: Answer 1 and 5: Lateral/anterior-posterior radiographs of the hip are not enough in this patient, as his line of impact may have affected his knees, lumbar and cervical area. Answer 2: CT scan may be reasonable, but it is not as time or cost effective. In addition, the patient's knees, and cervical area should also be imaged. Answer 4: MRI is slow and not cost efficient. In a trauma setting, x-rays are more efficient in assessing the musculoskeletal effects of impact.
5.0
(4)
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