Ep 219 Hip Emergencies: Recognition and Management

Hip fractures and dislocations represent high-morbidity emergencies requiring rapid, systematic management in the emergency department. Mortality rates for hip fractures reach 20% within one year, necessitating surgical intervention within 24 hours to optimize outcomes. Effective emergency care centers on early pain management through ultrasound-guided hip blocks, which reduce delirium risk, and meticulous preoperative optimization, including medication reconciliation and NPO status. Diagnosis requires a high index of suspicion for occult fractures, especially in patients with normal radiographs, utilizing physical exam maneuvers like the active straight leg raise. For hip dislocations, rapid reduction—ideally using the Whistler technique—is essential to preserve femoral head viability and prevent sciatic nerve injury. Clinicians must distinguish between intra-articular and extra-articular pathology, maintaining vigilance for mimics like septic arthritis or femoral acetabular impingement in younger patients presenting with groin pain.