Download Hip Fractures - Orthopaedic Trauma - Lecture Slides and more Slides Orthopedics in PDF only on Docsity! Hip Fractures • General principles – With the aging of the American population the incidence of hip fractures is projected to increase from 250,000 in 1990 to 650,000 by 2040 – Cost approximately $8.7 billion annually – 20% higher incidence in urban areas – 15% lifetime risk for white females who live to age 80 Docsity.com Hip Fractures • Epidemiology – Incidence increases after age 50 – Female: Male ratio is 2:1 – Femoral neck and intertrochanteric fractures seen with equal frequency Docsity.com Hip Fractures • Management – Prompt operative stabilization • Operative delay of > 24-48 hours increases one-year mortality rates • However, important to balance medical optimization and expeditious fixation – Early mobilization • Decrease incidence of decubiti, UTI, atelectasis/respiratory infections – DVT prophylaxis Docsity.com Hip Fractures • Outcomes – Fracture related outcomes • Healing • Quality of reduction – Functional outcomes • Ambulatory ability • Mortality (25% at one year) • Return to pre-fracture activities of daily living Docsity.com Hip Fractures • Femoral neck fractures – Intracapsular location – Vascular Supply • Medial and lateral circumflex vessels anastamose at the base of the neck • blood supply predominately from ascending arteries (90%) • Artery of ligamentum teres (10%) Docsity.com Hip Fractures • Femoral neck fractures • Treatment: Hemiarthroplasty – Unipolar Vs Bipolar – Can lead to acetabular erosion, dislocation, infection Docsity.com Hip Fractures • Femoral neck fractures • Treatment – Displaced fractures can be treated non - operatively in certain situations • Demented, non-ambulatory patient – Mobilize early • Accept resulting non or malunion Docsity.com Hip Fractures • Intertrochanteric fractures – Extracapsular (well vascularized) – Region distal to the neck between the trochanters – Calcar femorale – Posteromedial cortex – Important muscular insertions Docsity.com Hip Fractures • Subtrochanteric Fractures – Begin at or below the level of the lesser trochanter – Typically higher energy injuries seen in younger patients – far less common in the elderly Docsity.com Hip Fractures • Subtrochanteric Fractures – Treatment • Intramedullary nail (high rates of union) • Plates and screws Docsity.com