Ch 4 - MSK: Lower Extremity Fractures Flashcards
What are nonmodifiable risk factors for hip fracture?
■ ~60% > 75 yo
■ Females> males
■ Females 2 to 3:1 European Americans: African Americans
What are modifiable risk factors for hip fracture?
■ Alcohol and caffeine ■ Smoking ■ Steroids, antipsychotics, benzodiazepines ■ Malnutrition ■ Body weight below 90% of ideal
What is the incidence of VTE in hip surgery?
> 50% of unprotected patients
Risk of PE is highest during 2nd and 3rd week
What is the incidence of HO in hip surgery?
> 50% THA
What is the mortality rate of hip fracture?
20% to 30% after 1 year 40% after 2 years
What are the classification types of hip fractures?
Intracapsular
Intertrochanteric
Subtrochanteric
What is a Garden classification Stage 1 of intercapsular hip fractures?
Incomplete, nondisplaced with occasional valgus angulation
What is a Garden classification Stage 2 of intercapsular hip fractures?
Complete, nondisplaced, occasionally unstable
What is a Garden classification Stage 3 of intercapsular hip fractures?
Displaced with the hip joint capsule partially intact
What is a Garden classification Stage 4 of intercapsular hip fractures?
Displaced with the hip joint capsule completely disrupted
What is the clinical presentation of hip fractures?
Hip pain
ER > normal
Shortened limb on the affected side
What are surgical treatments for Garden classification Stage 1 and 2 intercapsular hip fractures?
Pins across the fracture site or a cannulated hip screw is used for stabilization
What are surgical treatments for Garden classification Stage 3 and 4 intercapsular hip fractures?
Replacement of the femoral head using cemented or noncemented hemiarthroplasty; total hip replacement or bipolar arthroplasty
What do bimolar hip implants consist of?
Femoral component that articulates by snap-fit into a cup that moves freely within the acetabulum
What are the post-op WB restrictions for Garden classification Stage 3 and 4 intercapsular hip fractures?
Cemented: immediate full WB
Uncemented: partial or full WB
Which THA approach is more prone to dislocation?
Posterior
What are the total hip precautions after posterior THA?
Avoid hip flexion over 90°, hip adduction past midline, and extreme hip IR
What chair type is preferred after posterior THA?
Low height in order to reduce hip flexion and potential for posterior hip dislocation
What are the total hip precautions after anterior THA?
Avoidance of hip extension and ER
What is the most common type of hip fracture?
Intertrochanteric hip fracture
What can highly fragmented Intertrochanteric hip fractures result in?
Significant blood loss and hypovolemia
What are classifcations of Intertrochanteric hip fractures?
Nondisplaced
Displaced two-part fractures
Unstable three-part fractures
What are surgical treatments of Intertrochanteric hip fractures?
– Compression screw or angle nail plate
– If fixation is unstable, medial displacement osteotomy of the femur may be require
What is the weight bearin status after intertrochanteric femur fracture?
Progress from partial to full weight bearing
What are the classification types of subtrochanteric hip fractures?
Simple
Fragmented
Comminuted
What are the surgical treatments of subtrochanteric hip fractures?
– ORIF
– Blade plate and screws
– IM rod
What are the weight bearing restrictions of subtrochanteric hip fractures?
Weight bearing progresses from partial to full
Describe a compression type femoral neck fractures.
More common
Occur along inferior neck of femur
Stable
Describe a transverse type femoral neck fractures.
Fx along the superior aspect of the femur neck
Unstable
“Tension side fx”
Who are susceptible to proximal femoral neck fractures?
Runners
Triathletes
Millitary recruits
What is treatment for compression type femoral neck fractures?
– Bedrest
– WB to limitation of pain once no pain at rest
– Internal fixation if fracture progresses
What is treatment for transverse type femoral neck fractures?
ORIF due to the high risk of displacement
What is the cause of ischial tuberosity avulsion fracture?
Forceful hamstring contracture with the knee in extension and the hip in flexion
What is the clinical presentation of ischial tuberosity avulsion fracture?
- Acute onset pain and tenderness over the ischial tuberosity
- “Popping” or tearing sensation with palpable defect
- Pain on straight leg raise
What is the treatment of ischial tuberosity avulsion fracture?
- Rest, ice, WBAT
- Resistance exercises once full ROM
- Surgery for a displaced apophysis
What is a complication of ischial tuberosity avulsion fracture?
Rarely, there can be significant scar formation around the sciatic nerve in the posterior thigh
What is the cause of ASIS avulsion fracture?
Forceful contraction (e.g., kicking, running, jumping) with the hip extended and the knee flexed
What can cause parasthesia with ASIS avulsion fracture?
Lateral femoral cutaneous nerve can cause paresthesias in the anterolateral thigh
What is the clinical presentation of ASIS avulsion fracture?
- Acute pain and tenderness is present over the ASIS
* Pain on hip flexion
What is the treatment of ASIS avulsion fracture?
- Rest, ice, WBAT
- May require the knee to be splinted in flexion to reduce tension on the avulsion segment
- Stretching and strengthening
- Surgery may be required for a displaced apophysis
What is the cause of AIIS avulsion fracture?
Forceful kicking and contraction of the quadriceps
What is the clinical presentation of AIIS avulsion fracture?
- Acute onset pain over the AIIS or groin
* Pain produced with quadriceps contraction, hip flexion, or hip extension
What is the treatment of AIIS avulsion fracture?
- Rest, ice, WBAT
- Stretching and strengthening
- Surgery may be required for a displaced apophysis
What is osteitis pubis?
Inflammatory condition of the joint of the pubic rami caused by overuse of the adductors
What is the clinical presentation of osteitis pubis?
- Pubic symphysis or groin pain, may radiate into the thigh
- Normal ambulation may produce a popping in the pubic region
- Pain w/ resisted adduction and one-legged hopping
What is seen on CT/x-rays in osteitis pubis?
Periosteal thickening
What is myositis ossifcans?
Formation of heterotopic ossification within muscle
What is the cause of myositis ossifcans?
Repeated trauma to that area of muscle or can be due to a direct blow
What is the most common location of myositis ossifcans?
Quadriceps
What can exacerbate the myositis ossifcans process?
US
Heat
Massage
Repeated trauma
What is seen on radiographs of myositis ossifcans?
- Initially soft-tissue mass
- Calcific flocculations ~ 14 days
- Ossification ~ 2-3 wks
What is treatment of myositis ossifcans?
- Gentle ROM
- Prevention of contractures
- Strengthening of the involved muscles
- Surgery for nerve entrapment, dec ROM, or loss of function
- Surgery delayed until the lesion matures at 10 to 12 mo
- Radiation therapy for recalcitrant sx
