Hip OA s/p intertrochanteric hip fracture

[Timeoutofmind]

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Pt is 87

Fell and had an intertrochanteric fracture. S/p ORIF.

Now has pos exam for groin pain with ER/IR of the hip.

Surgeon doesnt want to do anything as the OA is mild he says.

Obviously not a fan of doing a hip IA inj given he had the fracture there.

I guess the only other thing I can think of is RF of the fem/obturator branch.

Any other ideas?

 

[swamprat]

DRG? I'd do fem/obt first though

 

[SSdoc33]

Pt is 87

Fell and had an intertrochanteric fracture. S/p ORIF.

Now has pos exam for groin pain with ER/IR of the hip.

Surgeon doesnt want to do anything as the OA is mild he says.

Obviously not a fan of doing a hip IA inj given he had the fracture there.

I guess the only other thing I can think of is RF of the fem/obturator branch.

Any other ideas?


View attachment 234065

when was the fx and ORIF?

if it was a while ago, then you can go ahead and inject the hip.

 

[swamprat]

when was the fx and ORIF?

if it was a while ago, then you can go ahead and inject the hip.

What’s ur timeline? Just curious

 

[SSdoc33]

What’s ur timeline? Just curious

i dont know. 4-5 months maybe

 

[Timeoutofmind]

when was the fx and ORIF?

if it was a while ago, then you can go ahead and inject the hip.

Bone is already osteopenic no, hence the fracture in the first place?
Isn’t there a danger of further weakening and another fracture?
Not sure I wanna deposut steroids in there...

 

[mdvol]

Bone is already osteopenic no, hence the fracture in the first place?
Isn’t there a danger of further weakening and another fracture?
Not sure I wanna deposut steroids in there...

Steroids not going to make it locally osteoporotic.

 

[SSdoc33]

Bone is already osteopenic no, hence the fracture in the first place?
Isn’t there a danger of further weakening and another fracture?
Not sure I wanna deposut steroids in there...

i would do the shot and not think twice about it. risk is minimal.

 

[SeniorWrangler]

I would do the injection on the condition that the patient start doing more hip exercises.
The fracture was in the neck, and the steroids are going into the intraarticular space.

 

[lobelsteve]

Would want other views of the hip.
Do the injection.
Would get THA done before anything but a hip injection.
The surgery in this view does not look like good anatomic alignment.
How about an AP pelvis?

 

[BobBarker]

Hip needs replaced based on that view. Way tight at 7:00, way open at 10:00, and a little tight at 12:00 to 3:00

 

[DODOCSS]

IA injection is diagnostic and hopefully therapeutic

 

[SSdoc33]

Hip needs replaced based on that view. Way tight at 7:00, way open at 10:00, and a little tight at 12:00 to 3:00

disagree. OA is not that bad. do the shot and move on. she's 87

 

[BobBarker]

disagree. OA is not that bad. do the shot and move on. she's 87

Yes, I agree with you factoring in her age.

 

[painfree23]

how often do you offer the injection?

 

[clubdeac]

every 3-4 months

 

[deleted185747]

Consider as a backup plan an ultrasound examination of illiopsoas bursa and injection as it causes anterior hip and groin pain worse with internal and external rotation if the bursa is TTP.