A novel diagnostic sign of hip fracture mechanism in ground level falls: two case reports and review of the literature

Abstract

IntroductionMost elderly hip fractures are the result of a ground level fall. Defining high risk falls and fracture mechanisms are important to develop successful hip fracture prevention programs. This case series presents a previously unreported diagnostic sign and for the first time documents a hip fracture mechanism for a knee impact injury from a ground level fall in two elderly patients.Case presentationCase 1 was a 65-year-old Caucasian woman who fell forward with initial contact to her left knee, sustaining an impacted femoral neck fracture of her ipsilateral left hip. Case 2 was a 92-year-old Caucasian woman who fell bending forward, impacting her left knee and sustaining a comminuted intertrochanteric fracture of her ipsilateral left hip. The fractures occurred as a result of unprotected ground level falls in a forward direction with initial impact to the knee. The knee contusions were located near Gerdy’s tubercle and appear characteristic of a direct impact injury.ConclusionThe physical finding of a small localized site of impact and/or contusion in the anterior aspect of the knee in both of these patients with radiographic evidence of an ipsilateral hip fracture would strongly suggest that a knee impact injury can transmit enough energy to the proximal femur by axial loading to result in the hip fracture. The physical finding described is a reliable indicator of this hip fracture mechanism.

The use of Latin terminology in medical case reports: quantitative, structural, and thematic analysis

“…Noteworthy is the contextual use of the expression in situ . As is evident from the foregoing, this phrase can be used in oncology ( carcinoma in situ ), as well as in the process of measurement taking, viewing anatomical structures, and medical simulation (for example, “She was treated operatively with an in situ cannulated hip screw fixation and healed completely within eight weeks” [ 21 ]), depending on the context. Hence, this is one of the most productive Latin lexical units in modern medical discourse.…”

Facilitators of and Barriers to Hip Protector Acceptance and Adherence in Long-term Care Facilities: A Systematic Review

“…Whenever possible, we advocate that education programs enlist older adult peer educators and/or family to facilitate knowledge transfer and exchange. Notably, in 1 study, convincing residents about the positive effects of hip protectors became more difficult each time a hip fracture occurred while protected, 67 suggesting that it is especially important to inform caregivers, residents, and families that hip protectors cannot prevent fracture in all circumstances 42 (eg, in situations of spontaneous fracture without any obvious external impact, 84 when the hip breaks because of a backward fall or a fall to the knees, 85 or when the hip protector is not correctly positioned 86 ).…”

Validation and psychometric properties of the commitment to hip protectors (C-HiP) index in long-term care providers of British Columbia, Canada: a cross-sectional survey

“…To test concurrent validity, we examined the ability of the two lower-order factors and the entire C-HiP Index to distinguish between subgroups of respondents that it should theoretically be able to distinguish between. Although hip protectors substantially reduce risk of hip fracture if worn during a fall, they cannot prevent hip fracture on every occasion, including cases of spontaneous fracture without any obvious external impact (e.g., [ 69 ]), when the hip breaks from impact to the buttocks during of a backwards landed fall or a fall to the knees (e.g., [ 22 , 70 ]), or when the hip protector is not positioned correctly over the greater trochanter (e.g., [ 71 , 72 ]). Forsen et al [ 73 ] reported that it became increasingly difficult to convince residents of the benefits of hip protectors after each time a hip fracture occurred while wearing a hip protector.…”