AdultPediatric
Cannot miss / life threats
Cannot miss / life threats
Diagnostic flow — check first
Diagnostic flow — check first
- Elderly fall + cannot bear weight → MRI (with & without contrast) if XR negative.
- Fever + refusal to bear weight → aspirate hip.
- Obese adolescent with knee pain → check hip (SCFE).
- Older male hip/back pain + hypotension → bedside US for AAA.
- Hip dislocation → reduce within 6 h to limit AVN.
Differential diagnosis — checklist
0/19
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Traumatic0/5
Atraumatic — joint / bone0/6
Pediatric0/4
Referred0/4
Initial ED workup
Bedside0/5
- Vitals + bedside US (AAA, FAST)
- Inspect for limb shortening, rotation, ecchymosis
- ROM (especially internal rotation, log roll)
- Distal NV exam, peripheral pulses
- Pelvic compression for instability
Labs0/3
- CBC, CRP/ESR, lactate
- Type & screen if trauma or AAA
- Joint aspiration if effusion + fever
Imaging0/4
- AP pelvis + lateral hip XR
- MRI (without contrast) for occult fracture, AVN, stress fracture
- CT for pelvic ring / acetabular injury
- US/CT for AAA, abscess
Initial management0/5
- Analgesia + fascia iliaca block for hip fracture
- Pelvic binder + MTP for unstable pelvic ring
- Emergent reduction for hip dislocation (within 6 h)
- Aspirate + ortho washout + IV abx for septic joint
- Vascular surgery for AAA
Pearls / pitfalls
Pearls
- Up to 10% of femoral neck fractures are missed on initial XR — MRI (with & without contrast) if clinical suspicion.
- Knee pain in a child = check the hip (SCFE, Perthes, septic).
- Fascia iliaca block reduces opioid use and delirium in elderly hip-fracture patients.