A 45-year-old construction worker is brought to the emergency department after falling from scaffolding and landing on his right side. He reports severe pain in his right hip, is unable to bear weight, and presents with obvious distress while holding his right leg in a specific position on the stretcher. Which assessment finding would be most indicative of a hip fracture?
The patient presents with obvious distress, holding his right leg in a specific position while lying on the stretcher.
1Right leg appears longer than the left leg with external rotation
2Right leg appears normal length with internal rotation
3Right leg appears shorter than the left leg with external rotation✓ 정답
4Right leg appears longer than the left leg with internal rotation
해설
Hip fractures typically cause the affected leg to appear shorter with external rotation due to muscle spasm and bone displacement. Other positions like internal rotation or leg lengthening are not characteristic of hip fractures.
Clinical Judgment
This question assesses the ability to identify the typical physical signs, which is the Core Concept of post-traumatic hip fractures. The key is understanding how the unbalanced muscle contraction due to the fracture affects the leg's appearance. In a hip fracture, the strong contraction of the Iliopsoas and External Rotators dominates, displacing the femoral head and fixing the leg in a specific position. As a result, the affected leg typically appears shortened and externally rotated. This is a decisive clue that distinguishes it from a simple sprain or contusion.
Memory Tip: The mnemonic to remember the typical posture of a hip fracture is "Short & External." S stands for Shortening, and E stands for External Rotation.
KR vs US: While the basic assessment principles are the same, in the US, there is a greater emphasis on Notify HCP! along with prompt preparation for diagnostic imaging (typically X-ray, and CT if needed) and surgical intervention. Additionally, fall prevention education and hip fracture recovery programs are systematically implemented.
Clinical Practice GuideWhen evaluating a patient complaining of post-traumatic hip pain and weight-bearing inability, check for the "Short & External" sign. This is a quick and important physical examination element that nurses can perform.Caution: Not all hip fractures present with this classic posture. The sign may be less obvious in nondisplaced fractures or certain types (e.g., intertrochanteric fracture). However, if there is a history of trauma and pain, radiographic examination is essential. In SATA (Select All That Apply) questions, this sign may appear as a correct answer along with "pain management," "neurovascular status assessment," and "educating the patient not to move."
Hip Fracture — Hip fracture. This is a term that encompasses fractures of the femoral head, neck, intertrochanteric, or subtrochanteric regions.
External Rotation — External rotation. This refers to the movement of a limb rotating outward from the midline of the body. In the case of a hip fracture, it is a posture where the foot and knee on the affected side point outward.
Shortening — Shortening. This is a phenomenon where the affected leg actually becomes shorter or appears shorter compared to the unaffected leg. It occurs due to upward displacement of bone fragments caused by muscle contraction in hip fractures.
Iliopsoas Muscle — Iliopsoas. It is a powerful flexor muscle that originates from the lumbar spine and pelvis and attaches to the lesser trochanter of the femur. In hip fractures, it contracts and pulls the femur upward, causing shortening.
Weight-Bearing — Weight bearing. This means putting weight on the leg when standing or walking. Patients with hip fractures are typically unable to bear weight at all due to pain and instability.