General Guideline Principles for Hip Fractures

for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Hip Fractures.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Overview of Hip Fractures

Frank and stress fractures of the hip are both types of fractures. Accidents involving vehicles or falls are the most common causes of occupational fractures.
The most frequent causes of stress fractures are repeated applications of unusual force over a brief period of hours to days.

Observation and the removal of the problematic exposure are typically used to treat these. Reducing stresses on the affected site could be helped by physical therapy to address movement system deficits, such as poor muscle function and motor patterns.

Related Terms

  • Stress Fracture

     

  • Hip Fracture

     

  • Femoral Fracture

     

  • Femoral Neck Fracture

     

  • Intracapsular Fracture

     

  • Intertrochanteric Fracture

     

  • Subtrochanteric Fracture

     

  • Acetabular Fracture

Initial Assessment of Hip Fractures

The initial assessment of a patient with a probable occupational hip fracture is typically simple because the patient’s history, the mechanism of the injury, and the incapacity to utilise the hip all offer compelling diagnostic information. It is vital to review the systems that also affect the knee, spine, abdomen, and genitourinary tract.

Diagnostic Criteria of Hip Fractures

The evaluation criteria for typical occupational hip fractures are summarised in the list of criteria that follows.

Diagnostic Criteria for Non-red-flag Conditions

  1. Diagnostic Studies of Hip Fractures for Bone Scan

    Bone Scan is recommended may help in the diagnosis of certain patients with acute, subacute, or chronic hip pain

    Indications: Patients with suspected osteonecrosis, Paget’s disease, tumour, or other elevated polyostotic bone metabolism in addition to hip fractures.

    Frequency/Dose/Duration: single scan Rarely, a second scan may be necessary after at least three months have passed and there has been a clinically significant change in the symptoms and signs that results in a significant shift in the diagnosis.

    Rationale: To assess trauma, bone scanning may be a useful diagnostic procedure (e.g., occult fractures). In general, bone scanning is not recommended for the evaluation of hip OA. There is no need for bone scanning in patients whose diagnosis is believed to be certain because it does not affect management or treatment.

     

  2. Computerised Tomography (CT)

    Computerised Tomography (CT) is recommended for assessing patients with hip fractures who are at risk for osteonecrosis, especially after traumatic dislocations or recurrent dislocations brought on by arthroplasty. Besides, CT for patients who require advanced imaging, but have MRI disqualifications.

    Indications: Patients with hip fractures who are experiencing osteonecrosis-related pain and who may also have subchondral fractures, enhanced polyosthotic bone metabolism, or traumatic hip dislocations, especially when femoral head or acetabular fracture fragments are desired; repeated hip dislocations brought on by arthroplasty evaluate the anteversion (rotational alignment) of the patients with acetabular and femoral components; MRI contraindications.

    Frequency/Dose/Duration: One evaluation. A second evaluation is rarely needed.

    Rationale: When sophisticated imaging of calcified bones is needed for the majority of hip problems, computerised tomography is thought to be preferable to MRI.

     

  3. Helical CT Scan

    Helical CT Scan is recommended for a specific group of patients with hip fractures suspected to develop osteonecrosis or in need of advanced bone imaging but with MRI contraindications (implanted hardware).

    Indications: Patients with hip fractures who may have osteonecrosis or who require advanced bone imaging but for whom MRI is not appropriate. Helical CT often expedites scanning time, eliminates motion artefact, and is good for vascular problems.

    Frequency/Dose/Duration: one assessment Rarely is a second evaluation necessary.

    Rationale: MRI has substantially taken the place of helical CT scanning. However, it is believed to be more accurate than MRI when assessing subchondral fractures. Additionally, some patients (such as those with implanted ferrous metal hardware) are contraindicated for MRI; in these cases, helical CT is recommended for patients who need to have their AVN evaluated.ended.

     

  4. Magnetic Resonance Imaging (MRI)

    Magnetic Resonance Imaging (MRI) is recommended for a small group of patients with hip fractures who also experience subacute or persistent hip pain, taking into account any associated soft tissue pathology or other diagnostic worries.

    Indications: Patients with hip pain that is subacute or chronic who require imaging of the surrounding soft tissues, including assessing any periarticular masses or structures (normally not recommended for hip pain that is acute as radiographs typically suffice).

    Frequency/Dose/Duration: Typically, just one test should be necessary. Rarely is a second evaluation necessary.

    Rationale: For examinations of patients with symptoms longer than three months, MRI has been recommended.

     

  5. Radiographs

    Radiographs are recommended to assess hip fractures.

    Indications: all patients who could suffer a hip fracture. Additionally, if there are no warning signs but you have moderate to severe hip discomfort that lasts for at least a few weeks and/or restricted range of motion.

    Frequency/Dose/Duration: Typically, one set of x-rays is enough. It might make sense to have a second series of x-rays for individuals with persistent or worsening hip pain, especially if their symptoms alter.

     

  6. Ultrasound

    Ultrasound of Hip Fractures is not recommended for assessing individuals with hip fractures. There is support for using ultrasound (US) to assess individuals with hip fractures.

Medications of Hip Fractures

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs.

There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.

  1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs)

    Non-Steroidal Anti-inflammatory Drugs (NSAIDs) is recommended for the purpose of treating hip fracture-related pain.

    Indications: For treatment of pain associated with hip fractures, NSAIDs are recommended for treatment. Over-the-counter (OTC) agents may suffice and should be tried first.

    Frequency/Duration: As needed use may be reasonable for

    many patients.

    Indications for Discontinuation – Pain relief, ineffectiveness, or the emergence of side effects that need stopping.

     

  2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

    NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors are commonly used together by individuals who are at high risk for gastrointestinal bleeding.

    Frequency/Dose/Duration – H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

    Indications for Discontinuation – Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

     

  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended As far as cardiovascular side effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options. If necessary, non-selective NSAIDs are recommended to COX-2-specific medications.

    To reduce the chance that an NSAID will negate the therapeutic benefits of low-dose aspirin in patients receiving it for the prevention of primary or secondary cardiovascular disease, the NSAID should be given at least 30 minutes after or eight hours before the daily aspirin.

     

  4. Acetaminophen

    Acetaminophen for Treatment of Hip Pain is recommended for the treatment of hip fracture pain, especially in patients who are contraindicated for NSAIDs.

    Indications: Acute, subacute, chronic, and post-operative hip fracture pain in all individuals.

    Dose/Frequency: As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of liver toxicity.

    Indications for Discontinuation: pain, side effects, or intolerance are gone.

     

  5. Bisphosphonates

    Bisphosphonates of Hip Fractures is recommended for selected patients with hip fractures brought on by osteopenia.

    Indications: Patients with hip fractures believed to be the result of osteoporosis or osteopenia should be monitored to avoid further fractures. Increased bone mineral density is a benefit. lower possibility of secondary fractures.

    Frequency/Dose/Duration: As per manufacturer Recommendations.

     

  6. Calcitonin

    Calcitonin is not recommended for hip fracture patients.

     

  7. Opioids

    Opioids of Hip Fractures is recommended for the management of a subset of patients with hip fractures after surgery

    Indications – A brief opioid course of a few days to no more than one week is advised for the treatment of post-operative hip fractures. Following surgery, a small nocturnal dose of opioids may be beneficial.

    Opioids are not advised for people with other types of hip fractures. Prior to using opioids, the majority of patients should try NSAIDs and acetaminophen for pain relief. It is advised to stop using opioids as soon as possible.

    Frequency/Dose/Duration – For the majority of hip surgeries, patients typically only need a few days to a week of opioid medication.

    Indications for Discontinuation – Hip fracture pain has subsided, the pain is adequately controlled by other medications, the medication is ineffective, or there have been side effects that require stopping.

Treatments of Hip Fractures

  1. Hot and Cold Therapies Cryotherapy for Acute, Subacute, Chronic, or Post-operative Hip Pain

    Hot and Cold Therapies Cryotherapy for Acute, Subacute, Chronic, or Post-operative Hip Pain are recommended for hip pain that is immediate, ongoing, chronic, or post-operative.

    Indications – All patients with hip pain.

    Frequency/Duration – As many as three to five self-applications every day.

    Indications for Discontinuation – Resolution, negative consequences, and noncompliance.

     

  2. Heat Therapy for Acute, Subacute, Chronic, or Post-operative Hip Pain

    Heat Therapy for Acute, Subacute, Chronic, or Post-operative Hip Pain are recommended for hip pain that is immediate, ongoing, chronic, or post-operative.

    Indications – All patients with hip pain.

    Frequency/Duration – Approximately three to five self-applications per day as needed.

    Indications for Discontinuation – Resolution, negative consequences, and noncompliance.

Surgery of Hip Fractures

  1. Surgery of Surgical Intervention for Hip Fracture

    Surgery of Surgical Intervention for Hip Fracture is recommended as soon as the patient is medically stable.

    Indications: Hip fractures.

    Rationale: The surgical procedures and fixing materials employed vary greatly. The treating surgeon determines the kind of surgical procedure (such as a pin, screw, or nail) or non-operative care.

     

  2. Arthroplasty for Hip Fractures

    Arthroplasty for Hip Fractures is recommended especially for patients with subcapital fractures and displaced femoral necks.

     

  3. Hemiarthroplasty

    Hemiarthroplasty of Hip Fractures is recommended for patients with subcapital fractures and displaced femoral neck.

    Indications: hip fractures, particularly subcapital and displaced femoral neck fractures.

     

  4. Systemic Antibiotics

    Systemic Antibiotics is recommended for people having hip surgery; usually used for one day. For patients having hip surgery, particularly those who have prosthetics.

    Indications: Systemic prophylactic antibiotics are widely used and are regarded as essential. Benefits: Lower chance of infection in joints or prosthetics.

    Systemic Antibiotics is recommended for the treatment of skin infections (post operative complications).

    Indications: For the treatment of recurring infections and postoperative problems

     

  5. Treatment of Infected Prosthesis

    Treatment of Infected Prosthesis of Hip Fractures is recommended A dangerous result that typically necessitates surgical debridement, drainage, and the right medicines is an infected prosthesis. The removal of implanted hardware may also be necessary as part of the treatment, which typically entails lengthy IV antibiotics.

     

  6. Treatment of Dislocations

    Treatment of Dislocations is recommended Referrals back to the treating surgeon should be made when necessary to lessen dislocation and the likelihood of recurrence.

Other of Hip Fractures

Acupuncture of Hip Fractures

Acupuncture of Hip Fractures is recommended following hip replacement surgeries.

Indications: Hip replacement patients.

Frequency/Dose/Duration: three postoperative days maximum.

Rationale: Acupuncture is effective for individuals who have had hip arthroplasty, as shown by two high-quality trials. This has helped to lower opioid requirements.

What our office can do if you have a Hip Fracture

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

Call Us Now!

5.0
Based on 96 reviews
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
js_loader

Disclaimer

Complete Orthopedics is a medical office and we are physicians . We are not attorneys. The information on this website is for general informational purposes only.

Nothing on this site should be taken as legal advice for any individual case or situation. The information posted is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship or a doctor-patient relationship nor shall the information be used to form an legal or medical opinions.

You should not rely on any of the information contained on this website. You should seek the advice of a lawyer or physician immediately for more accurate information surrounding any legal or medical issues.

This information has been posted for informational and/or advertisement purposes only. You consent to these terms and conditions by using our website

I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

You can see my full CV at my profile page.