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Periprosthetic Fracture
46yo with a previous R THR presented post fall while intoxicated the night before.
She couldn't WT bear R leg.
On examination she had good ROM R hip, tender proximal thigh with maybe R thigh asymmetric swelling ?haematoma. Obs normal.
US showed a lovely periprosthetic fracture. In the adult leg, I use the abdominal transducer because it has greater depth penetration and good superficial resolution. But if you wanted better images, you could use a linear transducer.
When looking at a bone, you want to see a bright hyperechoic line with shadowing posteriorly. Fan medially and laterally until the bone line is crisp and thin, then translate the transducer inferiorly or superiorly looking for a break in the line suggesting a fracture.
R femur long (annotated below)
I probably should have done a fascia iliaca block as soon as I saw this, but I was a coward and got an expedited XR instead.
XR below:
