Any Orthopaedic surgoens out there by any chance who can answer this....?

Question

If a patient goes to A&E unable to walk and is suspected of having a hairline crack in the femoral neck, would you say that sending them home partially weightbearing then not carrying out an isotopic bone scan for 2 weeks is unacceptable? This happenend to me and on the day they finally did the scan I broke my hip completely getting out of the shower. I was only 22 at the time - shouldn't they have scanned and operated on the hairline fracture quicker?

Yes, in fact as this then led to a poorly done operation, ultimately meaning I had a hip replacement at 23, I began legal proceedings. 4 years later I am going to lose the case on the basis that apparently 14 days is an acceptable time to wait!! What bollux!!

Answer 1

two words:

LAW SUIT!!

:)
merlin the cat

Answer 2

The answer is it depends. The blood supply to the hip joint is very unique. Certain part of the blood supply comes directly from the femoral neck itself while other part are supplied by feeding vessels along the bone. I suspect the area of your fracture is near the border of this blood supply dilenma and if you have got only a crack then the conservative treatment is entirely appropriate. This is because the blood supply to the femoral head may not be completely severed and there is a good chance that whatever bit is not broken still has a good blood supply. If the blood supply is compromised then avascular nercosis (AVN) sets in, meaning the femoarl head (the ball of the hip joint) will die, leading to hip replacement. It is impossible to second guess what the bone would do and therefore conservative treatment in the first instance is entirely appropriate. Bone scan will only tell you whether the bone is healing or not.

Think about it this way. If the blood supply is compromised as it is in your case, you would still have to have a hip replacement whenever the final diagnosis was made, be it one or two weeks post injury. Replacement hip is never as good as your own and therefore it would be in your interest to give the bone a chance to heal as there was a chance that the blood supply was still intact (given the fact that it was a hairline crack rather then complete break). You would have got ground to sue if they proceed to a hip replacement in the first instance. What they have done they did in your best interest.

For your information, isotope bone scan is a diagnostic scan where calcium isotope are injected into you and hours later you go into a scanner to see where there is extra uptake/distribution of calcium. These are usually fracture sites, area of bone metastasis, or in Paget's disease.

Adrian (A&E doctor in UK)

Answer 3

femoral neck fractures are always tricky, in the respect that there are blood vessels supplying the femoral neck in the neck of femur. well to be truthful, here in India we do not go for bone scanning immediately, that is mostly because of the unavailability of the scanners. we usually put the patients through regular x ray. i must admit that we sometimes miss the hairline fractures.
in your case i feel that they should have undergone with the scan. on the other hand since fracture was hairline, and 14 days window period is given for the bone to show signs of AVN or avascular necrosis. i must admit that hairline fractures don't usually go for compound fractures unless something drastic happens. with partial weight bearing things should have been normal. and usually there in no need to go for operations at the outset in case of hairline fractures, only after 2-3 weeks if bone appears to be going for necrosis then it is necessary.
hope that answers your question.

Answer 4

Hindsight is a wonderful thing.

They just want you out of the door and not taking up a bed these days.

I wonder what would happen if people refused to leave hospitals until their concerns (as yours) were fully laid to rest.

Answer 5

Im a physical therapist, not an ortho, but that sounds pretty ridiculous to me!