1. Scene Assessment and Triage:
– Ensure scene safety
– Perform primary survey (ABCDE approach)
– Immobilize the patient if spinal injury is suspected
2. Pre-hospital Care:
– Provide pain management
– Apply pelvic binder if pelvic fracture is suspected
– Initiate fluid resuscitation if signs of shock are present
3. Emergency Department Evaluation:
– Conduct secondary survey
– Obtain detailed history of the accident mechanism
– Perform focused hip and pelvis examination
– Assess neurovascular status of lower extremities
1. Imaging Studies:
– Plain radiographs (AP pelvis, lateral hip)
– CT scan for detailed fracture assessment
– MRI for soft tissue injuries and occult fractures
2. Laboratory Tests:
– Complete blood count
– Coagulation profile – Serum electrolytes and renal function tests
3. Additional Investigations:
– Angiography if vascular injury is suspected
– Nerve conduction studies for neurological deficits
1. Fractures:
– Femoral head fractures
– Femoral neck fractures
– Intertrochanteric fractures
– Subtrochanteric fractures
2. Dislocations:
– Posterior hip dislocations
– Anterior hip dislocations
3. Soft Tissue Injuries:
– Labral tears
– Muscle strains (e.g., iliopsoas, rectus femoris)
– Ligamentous injuries
4. Combined Injuries:
– Fracture-dislocations
– Associated pelvic ring injuries
1. Non-operative Management: Indications:
– Stable, non-displaced fractures
– Certain soft tissue injuries
Techniques:
– Protected weight-bearing
– Pain management
– Physical therapy
– Assistive devices (crutches, walker)
2. Operative Management: Indications:
– Displaced fractures
– Unstable fractures
– Hip dislocations with associated fractures
Surgical Techniques:
– Open reduction and internal fixation (ORIF)
– Closed reduction and percutaneous fixation
– Arthroplasty (hemiarthroplasty or total hip replacement)
– Arthroscopic procedures for labral repairs
3. Emergency Procedures:
– Closed reduction of hip dislocations
– External fixation for unstable pelvic injuries
1. Pharmacological Interventions:
– NSAIDs for mild to moderate pain
– Opioids for severe pain
– Muscle relaxants for associated muscle spasms
2. Non-pharmacological Approaches:
– Ice therapy
– Positioning and immobilization
– Transcutaneous electrical nerve stimulation (TENS)
3. Interventional Techniques:
– Intra-articular injections
– Nerve blocks (e.g., fascia iliaca block)
1. Acute Phase (0-2 weeks):
– Pain and swelling management
– Gentle range of motion exercises
– Isometric muscle strengthening
– Gait training with assistive devices
2. Subacute Phase (2-6 weeks): – Progressive weight-bearing as tolerated
– Increased range of motion exercises
– Strengthening exercises for hip and core muscles
– Balance and proprioception training
3. Late Phase (6-12 weeks):
– Full weight-bearing activities
– Advanced strengthening exercises
– Functional training
– Sport-specific or occupation
-specific exercises
4. Return to Activities:
– Gradual return to daily activities
– Work hardening programs
– Sports-specific training for athletes
1. Avascular Necrosis:
– Regular radiographic follow-up
– Core decompression in early stages
– Arthroplasty for advanced cases
2. Post-traumatic Arthritis:
– Conservative management with physical therapy and pain control
– Arthroplasty for severe cases
3. Heterotopic Ossification:
– Prophylaxis with NSAIDs or radiation therapy
– Surgical excision if functionally limiting
4. Venous Thromboembolism: – Early mobilization
– Mechanical prophylaxis (compression stockings)
– Pharmacological prophylaxis (low molecular weight heparin)
5. Neurovascular Injuries:
– Close monitoring of neurovascular status
– Surgical exploration and repair if indicated
1. Elderly Patients:
– Higher risk of complications
– Early mobilization to prevent deconditioning
– Osteoporosis management
– Fall prevention strategies
2. Polytrauma Patients:
– Prioritization of injuries
– Damage control orthopedics in unstable patients
– Multidisciplinary approach to care
3. Athletes:
– Accelerated rehabilitation protocols
– Sport-specific functional training
– Psychological support for return to sport
4. Pregnant Patients:
– Modified imaging techniques to minimize radiation exposure
– Careful medication selection
– Positioning considerations during treatment
1. Regular Clinical Assessments:
– Pain evaluation
– Functional outcome measures
– Quality of life assessments
2. Imaging Studies:
– Serial radiographs to monitor healing and detect complications
– Advanced imaging (CT, MRI) as indicated
3. Ongoing Rehabilitation:
– Home exercise programs
– Periodic physical therapy reassessments
– Lifestyle modifications for joint protection
4. Psychosocial Support:
– Screening for post-traumatic stress disorder
– Referral to mental health services if needed
– Support groups for MVA survivors
1. Minimally Invasive Techniques:
– Percutaneous fixation methods
– Computer-assisted surgery
2. Biological Augmentation:
– Platelet-rich plasma injections
– Stem cell therapy for cartilage regeneration
3. Advanced Imaging Modalities:
– 3D printing for pre-operative planning
– Functional MRI for assessing muscle activation patterns
4. Wearable Technology:
– Smart implants for real-time monitoring of healing
– Exoskeletons for gait assistance during rehabilitation
5. Virtual Reality in Rehabilitation:
– Immersive environments for balance training
– Gamification of exercise programs for improved adherence
