Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 31 views

    Hip Fractures: by Tariq Khan

    Uploaded by

    Kamran Khan Khalil
    HIP FRACTURES The document discusses hip fractures, including the anatomy, classification, risk factors, clinical assessment, treatment principles and types of surgery. It describes the blood supply to the femoral head, Garden classification of fractures, and risk factors like age, gender, nutrition and medications. Evaluation involves history, physical exam assessing leg rotation and mobility. Treatment principles are early surgery, DVT prophylaxis and types include internal fixation, hemiarthroplasty or total arthroplasty. Post-op care focuses on nutrition, mobilization and rehabilitation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    Hip Fractures: by Tariq Khan

    Uploaded by

    Kamran Khan Khalil
    31 views42 pages
    HIP FRACTURES The document discusses hip fractures, including the anatomy, classification, risk factors, clinical assessment, treatment principles and types of surgery. It describes the blood supply to the femoral head, Garden classification of fractures, and risk factors like age, gender, nutrition and medications. Evaluation involves history, physical exam assessing leg rotation and mobility. Treatment principles are early surgery, DVT prophylaxis and types include internal fixation, hemiarthroplasty or total arthroplasty. Post-op care focuses on nutrition, mobilization and rehabilitation.

    Original Description:

    medical

    Original Title

    medi

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    HIP FRACTURES The document discusses hip fractures, including the anatomy, classification, risk factors, clinical assessment, treatment principles and types of surgery. It describes the blood supply to the femoral head, Garden classification of fractures, and risk factors like age, gender, nutrition and medications. Evaluation involves history, physical exam assessing leg rotation and mobility. Treatment principles are early surgery, DVT prophylaxis and types include internal fixation, hemiarthroplasty or total arthroplasty. Post-op care focuses on nutrition, mobilization and rehabilitation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    31 views42 pages

    Hip Fractures: by Tariq Khan

    Uploaded by

    Kamran Khan Khalil
    HIP FRACTURES The document discusses hip fractures, including the anatomy, classification, risk factors, clinical assessment, treatment principles and types of surgery. It describes the blood supply to the femoral head, Garden classification of fractures, and risk factors like age, gender, nutrition and medications. Evaluation involves history, physical exam assessing leg rotation and mobility. Treatment principles are early surgery, DVT prophylaxis and types include internal fixation, hemiarthroplasty or total arthroplasty. Post-op care focuses on nutrition, mobilization and rehabilitation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    You are on page 1of 42

    HIP FRACTURES

    BY TARIQ KHAN

    Anatomy

    Blood Supply
    intracapsular are at risk

    of non union and avascular necrosis due to interruption of the blood supply to the femoral head
    Via cruicate (med and

    lat circumflex) and intramedullary

    Garden classification

    Risk Factors
    Age: >65 years

    Co-morbid factors: osteoporosis, endocrine disorders


    (hyperthyroidism, hypogondaism), GIT disorders interfering with calcium/ Vit D absorption, neurological disorders (Parkinsons, MS)

    Gender: F RTA

    Risk Factors
    Nutrition: lack of calcium and Vit D in diet, eating disorders
    (anorexia), high caffeine intake

    Smoking

    Alcohol
    Medication: steroids, anticonvulsants, diuretics Environmental factors:
    dim lighting, cluttered floors

    Classification
    Classified on

    geographical position:
    intracapsular: Subcaptial Transcervical basicervical Extracapsular: Intertrochanteric subtrochanteric

    Garden Classification
    Garden I: incomplete fracture of
    the femoral neck

    Garden II: complete fracture


    without displacement

    Garden III: complete fracture


    with partial displacement

    Garden IV: complete fracture


    with full displacement

    Anatomy of Femur
    Valgus reduction: Reduction should leave neck shaft angle between 130-150 deg Accepable reduction may have up to 15 deg of valgus >185 deg at risk of AVN Varus reduction: Results in higher non-union rate Not an anatomical reduction may lead to post op displacement (Weinrobe 1998) Angulation: reduction should be between 0-15 deg of anteversion

    Subcapital Fracture:
    Most common

    intracapsular fracture of the hip X-ray: white line of increased density of impacted bone may be seen at base of femoral head

    Transcervical
    Fracture
    Occurs across neck of

    femur Easy to view when hip xray obtained in internal rotation varus deformity

    Basicervical
    Fracture
    Base of femoral neck

    Extracapsular Fractures
    Inter-trochanteric fracture. Sub-trochanteric fracture

    Intertrochanteric Fracture
    Most common

    extracapsular hip fracture May results in varus deformity Classified by Evans as stable or unstable Most commonly used classification is Jensen where type 1&2 are stable and 3-5 are unstable

    Jensen Classification

    Subtrochanteric Fracture
    Classified by

    Seinsheimer:
    divided into undisplaced, two part, and comminuted

    Seinsheimer classification

    Clinical Assessment
    History:

    H/o fall in a small percentage it occurs spontaneously C/o pain and inability to move the hip or put weight H/o other osteoporotic fractures: Colles or vertebral fractures

    TRAUMA Direct Indirect

    Vehicular accedents
    Fall from height Crushing accidents

    Avulsion fractures

    Clinical Assessment Physical Exam


    Leg externally rotated Shortening May show trochanteric ecchymosis Inability to lift the extended leg ROM is limited and painful Distal neurovascular exam Check the pelvis
    -

    Move posterior to anterior at the level of iliac crests Lateral to medial through the iliac crests

    CLINICAL PICTURE

    SYMPTOMS:

    History of trauma, Pain, Swelling,

    Limited movements.

    SIGNS
    LOCAL: Swelling, Ecchymosis, Tenderness, Limited movements Deformity, Length discrepancy, Abnormal movements, Crepitus

    EXTERNAL ROTATION INABILITY TO LIFT EXTENDED LEG

    Treatment Principles
    Early surgery / 24-48h in patients who are medically stable May wait up to 72h to stabilize the pt. Assess cardiac risk Delay in surgery/prolonged bed rest means:
    increased risk of DVT, UTI, pulmonary complications,

    skin breakdown, delayed functional recovery

    Treatment Principles DVT Prophylaxis


    Fatal PE in 4-7% of patients undergoing hip surgery, Risk of bleeding 3.5% compared to 2.9% without anticoagulation Heparin 5000U q12h or LMWH upon admission Pneumatic compression additional to heparin Continue prophylaxis until patient is fully ambulatory

    treatment
    Coservative
    tractoin: skin traction skeletal traction

    Operative
    reduction and internal fixation arthroplasty : Hemiarthroplasty total arthroplasty

    TREATMENT OF CLOCED FRACTURES UNDISPLACED REDUCIBLE CONSERVATIVE TREATMENT 1-TRACTION


    SKELETAL TRACTION

    Types of Surgery

    Minimally displaced femoral neck fracture

    Internal fixation with multiple screws

    Prosthetic replacement

    Displaced Femoral neck Fracture esp. in elderly pt.

    HEMIARTHROPLASTY TOTAL ARTHROPLASTY

    Prosthetic replacement: HIP PROSTHESIS

    TOTAL ARTHROPLASTY

    HEMIARTHROPLASTY

    Hemiarthroplasty Hip:
    Indications:
    Poor general health Pathological hip fracture

    Contraindication:
    Pre existing sepsis Young patient

    Severe osteoprosis
    Physiological age >70 Inadequate closed

    Failure of internal

    reduction Pre-existing hip disease

    fixation device Pre-existing disease of the acetabulum

    Hemiarthroplasty Hip:
    Hemi associated with

    (Luyao 1994, lorio 2001)

    Lower reoperation rate (6-18% vs. 20-36%) Improved functional scores Less pain More cost-effective Slightly increased short term mortality

    Types of Surgery

    Displaced Femoral neck Fracture

    Prosthetic replacement

    Types of Surgery

    Intertrochanteric fracture

    Internal fixation with dynamic hip screw

    INTER TROCHANTERIC FRACTURE DHS

    DCS

    GAMMA NAIL

    Post-operative Care
    Nutrition: oral protein supplementation with shorter hospital stay Foley - for 24h only,

    - early removal results in less retention, earlier spontaneous voiding, less UTI
    Anticoagulant prophylaxis Total hip precautions:
    -

    No adduction past midline use abduction pillows, No hip flexion beyond 90 (tall comode, no bending >90 No internal rotation keep toes upright in bed

    Rehabilitation
    Goal independent living Rehabilitation should begin first day after surgery with transfer from bed to chair Progress as soon as possible to standing and walking (2nd day post op) Promote weight bearing with assistance walker

    SYSTEMIC COMPLICATIONS
    LONG RECOMBANCY IN BED DVT, PE,,, MORTALITY

    LOCAL COMPLICATIONS
    Loss of fixation 15%of patients: internal fixation for displaced fractures Malunion COXA VARA Nonunion mo/years after internal fixation for displaced fractures Avascular necrosis of femoral head (osteonecrosis) Dislocation of the prosthesis early, related to infections or mal-insertion Loosening of prosthesis years after surgery

    Coxa vara
    Neck shaft angle

    DHERA MANANA

    You might also like