Physiological Integrity Q 39
The elderly client is admitted to the emergency room. Which symptom is the client with a fractured hip most likely to exhibit?
A. Pain
B. Misalignment
C. Cool extremity
D. Absence of pedal pulses
Correct Answer: B. Misalignment
The client with a hip fracture will most likely have a misalignment. Most hip fractures can be diagnosed, or at least suspected, from history alone. Classically a fall leads to a painful hip with an associated inability to walk. Clinicians should explore potentially sinister causes of the fall, such as syncope, stroke, or myocardial infarction.
Option A: Pain is a prominent feature in all fractures. The physical examination will demonstrate pain, immobility, and potentially a deformed limb. The degree of deformity seen is dependent on both the anatomical configuration of the fracture and the degree of displacement. The classically described presentation is a shortened and externally rotated limb due to the unopposed pull of the iliopsoas muscle that attaches to the lesser trochanter.
Option C: Coolness of the extremities is indicative of compartment syndrome. Further examination often reveals pain on any, or all, of the following: palpation in the groin or greater trochanter, axial loading of the hip, and ‘pin rolling of the leg. It is recommended that a cognitive assessment be performed in all patients presenting with hip fractures. Ideally, this should be done both on admission and post-operatively. The aim of this is to recognize patients with underlying dementia or those who are developing an acute delirium, both of which are associated with a poorer prognosis.
Option D: The absence of pulses is indicative of peripheral vascular disease. A full primary trauma and secondary trauma assessment should be performed to assess the patient for other injuries. It is always useful to assess the patient’s cardiovascular and respiratory status prior to undergoing surgery. Specific examinations to identify the cause of the fall should also be considered.