Hip Fractures - Orthopaedic Trauma - Lecture Slides, Slides for Orthopedics. Acharya Nagarjuna University
devaki
devaki21 December 2012

Hip Fractures - Orthopaedic Trauma - Lecture Slides, Slides for Orthopedics. Acharya Nagarjuna University

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Hip Fractures, Intertrochanteric Fractures, Cross Table Lateral, Occult Hip Fracture, Dvt Prophylaxis, Intracapsular Location, Valgus Impacted Fractures, Hemiarthroplasty are some points from this lecture. This lecture i...
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Diagnosis and Management of Osteoporotic Fractures

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

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Hip Fractures • Epidemiology

– Incidence increases after age 50 – Female: Male ratio is 2:1 – Femoral neck and intertrochanteric fractures

seen with equal frequency

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Hip Fractures

• Radiographic evaluation – Anterior-posterior

view – Cross table lateral – Internal rotation view

will help delineate fracture pattern

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Hip Fractures

• Radiographic evaluation – Occult hip fracture

• Technetium bone scanning is a sensitive indicator, but may take 2-3 days to become positive

• Magnetic resonance imaging has been shown to be as sensitive as bone scanning and can be reliably performed within 24 hours

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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

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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

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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%)

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Hip Fractures • Femoral neck fractures • Treatment

– Non-displaced/ valgus impacted fractures • Non-operative 8-15% displacement rate • Operative with cannulated screws • Non-union 5% and osteonecrosis is approximately

8%

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Hip Fractures

• Femoral neck fractures – Displaced fractures should be treated operatively – Treatment: Open vs. Closed Reduction and Internal

fixation • 30% non-union and 25%-30% osteonecrosis rate • Non-union requires reoperation 75% of the time while

osteonecrosis leads to reoperation in 25% of cases

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Hip Fractures • Femoral neck fractures • Treatment: Hemiarthroplasty

– Unipolar Vs Bipolar – Can lead to acetabular erosion, dislocation,

infection

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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

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Hip Fractures

• Intertrochanteric fractures – Extracapsular (well vascularized) – Region distal to the neck between the trochanters – Calcar femorale – Posteromedial cortex – Important muscular insertions

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Hip Fractures

• Intertrochanteric fractures – Treatment

• Usually treated surgically • Implant of choice is a hip compression screw that

slides in a barrel attached to a sideplate • The implant allows for controlled impaction upon

weightbearing

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Hip Fractures

• Intertrochanteric fractures – Treatment

• Primary prosthetic replacement can be considered

• For cases with significant comminution

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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

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Hip Fractures

• Subtrochanteric Fractures – Treatment

• Intramedullary nail (high rates of union)

• Plates and screws

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