In any injury to the thigh causing shortening or approximation of its two attachments, the ilio-tibial band is relaxed. To examine for this, fingers should be pressed horizontally above the great trochanter or outer condyle of the femur. Lastly, the trochanter may be grasped and a careful attempt made to move it apart from the rest of the femur. All these movements must be gentle to avoid disimpacting an impacted fracture.
Eversion of the limb and loss of power are leading signs of fracture of the neck of the femur: only very rarely is the limb inverted; diagnosis rests on finding the trochanter raised and the limb shortened while the head is in its normal position. If, immediately after injury to the hip, eversion occurs with raising and flattening of the trochanter and prominence of the bone in Scarpa's triangle, there is a separation of the upper epiphysis of the femur.
If the head of the femur moves with the shaft without crepitus and the trochanter remains unchanged, there is no fracture or dislocation but severe contusion may cause everted limb. This injury can be followed by shortening of the limb and raising of the trochanter from absorption of the neck bone.
When examining for deformity of the trochanter in elderly patients, it could indicate a fracture of the great trochanter or an impacted fracture of the neck femur with the head driven into the pelvis. If the great trochanter is found to be movable, there is a fracture of the great trochanter; if these signs are found in children under 16 years old they indicate a diastasis of the great trochanter.
Dislocations of the hip can be diagnosed by absence of normal resistance caused by the head of the femur in the groin and great rigidity of the joint. The diagnosis must be completed by finding where the head of that bone is lying, whether behind the acetabulum or beneath the glutei muscles, or above the promontory of the ischial tuberosity.
Injuries about the knee include fractures of femur, tibia, patella, and separation of epiphysis. The surgeon should determine relations of tibia and femur, feel for head of fibula at back of outer condyle of tibia, and examine patella for displacement or fracture. Each bone should be examined separately for outline, mobility of a fragment, and crepitus.
If the patient cannot raise limb from couch and there is gap in tendon above patella or ligament below, it may show rupture of quadriceps tendon or patellar ligament. If with knee flexed tibia can be displaced backwards on femur, there is rupture of posterior crucial ligament. Increased lateral movement may indicate rupture of a lateral ligament.
Injury to semilunar cartilage is liable to be mistaken for impact of loose body in joint; attention to points such as sudden wrench causing dislocation and pain referred to side of joint will enable diagnosis.
Key Takeaways
- Identify signs like eversion, loss of power, and shortening for diagnosing femur neck fractures.
- Examine the trochanter and head of femur to distinguish between fracture and dislocation.
- Check for abnormal movements in knee to diagnose ligament ruptures or cartilage injuries.
Practical Tips
- Gently examine the ilio-tibial band for relaxation when suspecting thigh injury.
- Feel for crepitus and mobility of bone fragments during examination for fractures.
- Use X-rays to confirm suspected fractures, especially in cases like incomplete fissured fracture.
Warnings & Risks
- Avoid disimpacting an impacted fracture by moving the trochanter carefully.
- Be cautious when bending knee joint if patella or ligament may be fractured.
Modern Application
While this chapter's diagnostic methods are foundational, modern imaging techniques like X-rays and MRI provide more accurate diagnoses. However, understanding these historical examination skills is crucial for situations where advanced medical equipment isn't available.
Frequently Asked Questions
Q: What are the leading signs of a fracture in the neck of the femur?
The leading signs include eversion of the limb and loss of power. The trochanter may be raised, and the limb shortened while the head remains in its normal position.
Q: How can one distinguish between a fracture and dislocation of the hip?
A diagnosis is made by finding where the head of the femur lies: behind the acetabulum or beneath the glutei muscles, indicating dislocation; within its normal position with no crepitus indicates a severe contusion.
Q: What should be checked when examining for ligament ruptures in knee injuries?
Check if the tibia can be displaced forwards or backwards on the femur to diagnose anterior or posterior crucial ligament rupture, respectively. Increased lateral movement may indicate a lateral ligament rupture.