B6.075 Prework 4: Hip Fracture Flashcards
epidemiology of hip fracture
80% are women
almost all > 65
associated with increased mortality
nonmodifiable risk factors for hip fracture
age sex previous hip fracture low SES fam history of hip fracture
modifiable risk factors for hip fracture
falls (most significant)
decreased bone mineral density
reduced activity level
chronic med use
appearance of a hip fracture on physical exam
when patient is supine, leg held in external rotation and abduction, and appears shortened
diagnostic testing for hip fracture
plain radiograph is initial
frog leg should be avoided
MRI if radiograph is negative and fracture is still suspected
categories of hip fracture
extracapsular (intertrochanteric and subtrochanteric)
intracapsular (femoral head and neck)
which fractures heal well with ORIF
intertrochanteric
due to large amounts of cancellous bone and adequate blood supply
surgery reduces displaced bone and internally fixes fracture with plates or screws
treatment of subtrochanteric fracture
increased need for intramedullary rods or nails
higher rate of impact failure
due to high stresses on this part of the femur
what risk factors indicate a higher risk of bleeding in hip fracture
peritrochanteric fracture
initial Hg <12
age > 75
timing of surgery for hip fracture
early (24-48 hours) associated with earlier mobilization and rehabilitation, speeds recovery, and decreases risk of complications
who determines which surgery to do
orthopedic surgeon
usually ORIF or arthroplasty, don’t really know which is better
treatment of trochanteric fractures
usually isolated avulsion fractures
younger, active patients
heal with conservative, non operative management
1-2 hours before surgery
antibiotic prophylaxis
s. aureus, major concern
Cefalozin 1-2 g every 8 hr
12 hours before surgery
VTE prophylaxis with LMW heparin
extend up to 35 days
long term care after hip fracture
bisphosphonate therapy Ca and vit D supplements fall prevention assessment rehab therapy periodic radiography
