In addition, the neck-shaft angle of the uninjured femur can be used to guide reduction and plan for an anatomically matched surgical implant. The AP pelvis view allows for the comparison of both hips so that subtle abnormalities such as a minimally displaced pertrochanteric fracture can more easily be identified. Standard evaluation of pertrochanteric fractures include anteroposterior (AP) pelvis, AP hip, and cross table lateral hip radiographs. Careful examination of the joint above and below the injury of interest should also be performed. Thorough neurovascular assessment includes, but is not limited to testing the strength of the tibialis anterior, extensor hallucis longus, and gastrocnemius-soleus muscles as well as identifying any preexisting peripheral vascular disease or peripheral neuropathy. Neurovascular assessment is also important and should be performed and recorded prior to any manipulation or surgical intervention. Next, the hip should be palpated for tenderness in the general vicinity of the patient’s reported location of pain. Although rare, an open fracture must be excluded. Abrasions, ecchymosis, or lacerations may be found in the vicinity of the greater trochanter. Visual inspection of patients with displaced pertrochanteric fractures typically reveals a shortened and externally rotated lower extremity. Physical examination of the hip should include assessment of the entire lower extremity as well as any other location of associated injury. Pertinent medical history, including presence of preexisting osteoarthritis or known metastatic disease predisposing the patient to injury, past surgical history, allergies, medications taken, and social history including education level, occupation, activity level, religious or cultural beliefs which may affect care, alcohol usage, and tobacco consumption should also be obtained. Pain in other anatomic locations at the time of injury should also be queried. Additional specific conditions to identify in the patient’s history include pre-injury ambulatory status, antecedent hip pain, prior history of falls or dizziness, and loss of consciousness either before or after the fall. It is important to recognize this delay in presentation as medical optimization and rehydration of these patients is of paramount importance in order to get the patient to the operating room in a timely manner. In the predominantly geriatric population of pertrochanteric fractures, it is not uncommon for a patient to have had suffered the injury more than 24 h prior to presentation. It is imperative to determine the mechanism of injury and when the injury occurred. Most patients will report a fall from standing height or other low energy mechanisms resulting in immediate hip pain, a lower extremity deformity, and the inability to bear weight.
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