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BR 3rd Ed > Ch 4 - MSK: Lower Extremity Fractures > Flashcards

Ch 4 - MSK: Lower Extremity Fractures Flashcards

1
Q

What are nonmodifiable risk factors for hip fracture?

A

■ ~60% > 75 yo
■ Females> males
■ Females 2 to 3:1 European Americans: African Americans

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2
Q

What are modifiable risk factors for hip fracture?

A 
■ Alcohol and caffeine 
■ Smoking 
■ Steroids, antipsychotics, benzodiazepines
■ Malnutrition
■ Body weight below 90% of ideal
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3
Q

What is the incidence of VTE in hip surgery?

A

> 50% of unprotected patients

Risk of PE is highest during 2nd and 3rd week

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4
Q

What is the incidence of HO in hip surgery?

A

> 50% THA

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5
Q

What is the mortality rate of hip fracture?

A

20% to 30% after 1 year 40% after 2 years

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6
Q

What are the classification types of hip fractures?

A

Intracapsular
Intertrochanteric
Subtrochanteric

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7
Q

What is a Garden classification Stage 1 of intercapsular hip fractures?

A

Incomplete, nondisplaced with occasional valgus angulation

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8
Q

What is a Garden classification Stage 2 of intercapsular hip fractures?

A

Complete, nondisplaced, occasionally unstable

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9
Q

What is a Garden classification Stage 3 of intercapsular hip fractures?

A

Displaced with the hip joint capsule partially intact

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10
Q

What is a Garden classification Stage 4 of intercapsular hip fractures?

A

Displaced with the hip joint capsule completely disrupted

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11
Q

What is the clinical presentation of hip fractures?

A

Hip pain
ER > normal
Shortened limb on the affected side

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12
Q

What are surgical treatments for Garden classification Stage 1 and 2 intercapsular hip fractures?

A

Pins across the fracture site or a cannulated hip screw is used for stabilization

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13
Q

What are surgical treatments for Garden classification Stage 3 and 4 intercapsular hip fractures?

A

Replacement of the femoral head using cemented or noncemented hemiarthroplasty; total hip replacement or bipolar arthroplasty

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14
Q

What do bimolar hip implants consist of?

A

Femoral component that articulates by snap-fit into a cup that moves freely within the acetabulum

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15
Q

What are the post-op WB restrictions for Garden classification Stage 3 and 4 intercapsular hip fractures?

A

Cemented: immediate full WB
Uncemented: partial or full WB

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16
Q

Which THA approach is more prone to dislocation?

A

Posterior

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17
Q

What are the total hip precautions after posterior THA?

A

Avoid hip flexion over 90°, hip adduction past midline, and extreme hip IR

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18
Q

What chair type is preferred after posterior THA?

A

Low height in order to reduce hip flexion and potential for posterior hip dislocation

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19
Q

What are the total hip precautions after anterior THA?

A

Avoidance of hip extension and ER

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20
Q

What is the most common type of hip fracture?

A

Intertrochanteric hip fracture

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21
Q

What can highly fragmented Intertrochanteric hip fractures result in?

A

Significant blood loss and hypovolemia

22
Q

What are classifcations of Intertrochanteric hip fractures?

A

Nondisplaced
Displaced two-part fractures
Unstable three-part fractures

23
Q

What are surgical treatments of Intertrochanteric hip fractures?

A

– Compression screw or angle nail plate

– If fixation is unstable, medial displacement osteotomy of the femur may be require

24
Q

What is the weight bearin status after intertrochanteric femur fracture?

A

Progress from partial to full weight bearing

25
Q

What are the classification types of subtrochanteric hip fractures?

A

Simple
Fragmented
Comminuted

26
Q

What are the surgical treatments of subtrochanteric hip fractures?

A

– ORIF
– Blade plate and screws
– IM rod

27
Q

What are the weight bearing restrictions of subtrochanteric hip fractures?

A

Weight bearing progresses from partial to full

28
Q

Describe a compression type femoral neck fractures.

A

More common
Occur along inferior neck of femur
Stable

29
Q

Describe a transverse type femoral neck fractures.

A

Fx along the superior aspect of the femur neck
Unstable
“Tension side fx”

30
Q

Who are susceptible to proximal femoral neck fractures?

A

Runners
Triathletes
Millitary recruits

31
Q

What is treatment for compression type femoral neck fractures?

A

– Bedrest
– WB to limitation of pain once no pain at rest
– Internal fixation if fracture progresses

32
Q

What is treatment for transverse type femoral neck fractures?

A

ORIF due to the high risk of displacement

33
Q

What is the cause of ischial tuberosity avulsion fracture?

A

Forceful hamstring contracture with the knee in extension and the hip in flexion

34
Q

What is the clinical presentation of ischial tuberosity avulsion fracture?

A
  • Acute onset pain and tenderness over the ischial tuberosity
  • “Popping” or tearing sensation with palpable defect
  • Pain on straight leg raise
35
Q

What is the treatment of ischial tuberosity avulsion fracture?

A
  • Rest, ice, WBAT
  • Resistance exercises once full ROM
  • Surgery for a displaced apophysis
36
Q

What is a complication of ischial tuberosity avulsion fracture?

A

Rarely, there can be significant scar formation around the sciatic nerve in the posterior thigh

37
Q

What is the cause of ASIS avulsion fracture?

A

Forceful contraction (e.g., kicking, running, jumping) with the hip extended and the knee flexed

38
Q

What can cause parasthesia with ASIS avulsion fracture?

A

Lateral femoral cutaneous nerve can cause paresthesias in the anterolateral thigh

39
Q

What is the clinical presentation of ASIS avulsion fracture?

A
  • Acute pain and tenderness is present over the ASIS

* Pain on hip flexion

40
Q

What is the treatment of ASIS avulsion fracture?

A
  • 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
41
Q

What is the cause of AIIS avulsion fracture?

A

Forceful kicking and contraction of the quadriceps

42
Q

What is the clinical presentation of AIIS avulsion fracture?

A
  • Acute onset pain over the AIIS or groin

* Pain produced with quadriceps contraction, hip flexion, or hip extension

43
Q

What is the treatment of AIIS avulsion fracture?

A
  • Rest, ice, WBAT
  • Stretching and strengthening
  • Surgery may be required for a displaced apophysis
44
Q

What is osteitis pubis?

A

Inflammatory condition of the joint of the pubic rami caused by overuse of the adductors

45
Q

What is the clinical presentation of osteitis pubis?

A
  • 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
46
Q

What is seen on CT/x-rays in osteitis pubis?

A

Periosteal thickening

47
Q

What is myositis ossifcans?

A

Formation of heterotopic ossification within muscle

48
Q

What is the cause of myositis ossifcans?

A

Repeated trauma to that area of muscle or can be due to a direct blow

49
Q

What is the most common location of myositis ossifcans?

A

Quadriceps

50
Q

What can exacerbate the myositis ossifcans process?

A

US
Heat
Massage
Repeated trauma

51
Q

What is seen on radiographs of myositis ossifcans?

A
  • Initially soft-tissue mass
  • Calcific flocculations ~ 14 days
  • Ossification ~ 2-3 wks
52
Q

What is treatment of myositis ossifcans?

A
  • 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

BR 3rd Ed (92 decks)

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