Ch 4 - MSK: Lower Extremity Fractures Flashcards by Chris Garrison

What are nonmodifiable risk factors for hip fracture?

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

How well did you know this?

Not at all

Perfectly

What are modifiable risk factors for hip fracture?

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

How well did you know this?

Not at all

Perfectly

What is the incidence of VTE in hip surgery?

> 50% of unprotected patients

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

How well did you know this?

Not at all

Perfectly

What is the incidence of HO in hip surgery?

> 50% THA

How well did you know this?

Not at all

Perfectly

What is the mortality rate of hip fracture?

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

How well did you know this?

Not at all

Perfectly

What are the classification types of hip fractures?

Intracapsular
Intertrochanteric
Subtrochanteric

How well did you know this?

Not at all

Perfectly

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

Incomplete, nondisplaced with occasional valgus angulation

How well did you know this?

Not at all

Perfectly

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

Complete, nondisplaced, occasionally unstable

How well did you know this?

Not at all

Perfectly

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

Displaced with the hip joint capsule partially intact

How well did you know this?

Not at all

Perfectly

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

Displaced with the hip joint capsule completely disrupted

How well did you know this?

Not at all

Perfectly

What is the clinical presentation of hip fractures?

Hip pain
ER > normal
Shortened limb on the affected side

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What do bimolar hip implants consist of?

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Which THA approach is more prone to dislocation?

Posterior

How well did you know this?

Not at all

Perfectly

What are the total hip precautions after posterior THA?

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

How well did you know this?

Not at all

Perfectly

What chair type is preferred after posterior THA?

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

How well did you know this?

Not at all

Perfectly

What are the total hip precautions after anterior THA?

Avoidance of hip extension and ER

How well did you know this?

Not at all

Perfectly

What is the most common type of hip fracture?

Intertrochanteric hip fracture

How well did you know this?

Not at all

Perfectly

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