Fractured Neck of Femur Flashcards
Epidemiology
-Occurs mostly in elderly 80yo avg
§ Females: Males = 4:1
§ Mortality rate: 8-10% within 30 days, 21-29% 1 year
§ Regional Queensland 24.9% (Chia, 2013)
§ 50% decreased mobility, 1/3 regain pre-morbid function
§ Associated perioperative complications: pre-op hypoxia , post- op delirium, anaemia, representation within 30days, CHF, acute renal impairment, MI
Hip fracture causes
Simple fall - common in the elderly
Trip and fall Spontaneous Traumatic fall
- land on the hip (direct blow)
- common in elderly
- catches foot (rotational force)
- pathological
- e.g. osteoporosis+++
- e.g. MVA, skiing , etc.Hip fracture clinical features
Displaced - pain
- limb shortened/ER
- Unable to WB
Undisplaced - unable to weight-bear - pain - no change in limb orientation - can sometimes weight-bear - sometimes difficult to pick up on xray → MRI/CT or bone scan for diagnosis
Hip Fracture in the elderly, complications associated with
- pre-existing co-morbidities (physical / mental)
- additional fractures
- pain
- delayed assistance (cold, lying on hard
surface, etc.) - haematoma / damage to soft tissues - hospitalisation / change in environment
- surgery / anaesthetic
Hip fracture complications
§ Avascular necrosis § Non-union / mal-union § Dislocation § Shortening of leg § Infection § Non-healing of wound § Penetration of metal-ware § Metal-ware loosening § 2° osteoarthritis
Classification of Hip Fracture
Subcapital/intracapsular
intertrochanteric /extracapsular fracture
subtrochanteric fracture
Garden’s classification
Type I fractures have the best outcome. The bone ends are impacted into one another, which facilitates vascular re-growth.
Type II fractures are not impacted and are thus less stable. However there is minimal displacement of the bones from the anatomically normal position, and this is beneficial.
Type III fractures are complete but there is only partial displacement (<50%).
Type IV fractures are complete with total displacement (>50%). The two ends of bone are completely separated.
Surgical management of garden 1/2
cannulates screws
dynamic hip screw
Surgical management of garden III/IV
hemiarthroplasty
THJR
Surgical managment of intertrochanteric
DHS
Richards compression screw
compression hip screw
Surgical management of subtrochanteric
DHS, CHS Extramedullary fixation (pin/plate) IM reconstruction nail
Page 19 for general WB guidelines post op
19
Physiotherapy management of #NOF
§ Mobilise usually day -mobility ax
§ Often easily fatigueda-concentrate on functional activities only
§ Co-ordinate with nursing staff
§ Can generally WBAT, except if fixation stability = fragile or it is a relatively young patient, (about < 65 yrs ), in which case they are usually TWB or NWB only
Physiotherapy management #SOF
§ Usually rodded / nailed
§ Usually mobilise TWB, Day 1. Will be NWB if pin & plate
§ Need to work on knee flexion and quads. Promote regular
independent active work
§ Patient advised to rest with leg in elevation+++ for 10 days post-op.
Early aims of #NOF treatment
- early mobilisation (Day 1-2 post-op)
- encourage ambulation WBAT/TWB
- encourage maximal functional independence
- ensure adequate pain relief
- provide appropriate walking aid/s - ensure patient safety at all times
- discourage prolonged bed rest, but ensure adequate rest periods
Physiotherapy role - functional outcomes
Functional Outcomes § Level of assistance required for Physio Intervention § Early mobilization § Consider analgesia prior to mobilizing § Provide walking aids § Mobility status, ward function § Assess transfers § Falls prevention program § Exercises § Chest Physiotherapy § Circulation exercises § Hip precautions (if indicated) lying ↔ sitting ↔ standing § Balance § Willingness to weight-bear through # leg § Distance walked § Frame → crutches § ↑ and ↓ steps / ramp
