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ms 1 - 2nd shift > Fractures in the Hip Region + Arthroplasty > Flashcards

Fractures in the Hip Region + Arthroplasty Flashcards

1
Q

High energy trauma (motor vehicle accidents)

Fall from a height

Direct impact from the femoral head due to impact on the greater trochanter

Indirect trauma (dashboard injury where in the posterior wall of the acetabulum was fractured off by a dislocating femoral head)

A

Acetabular Fracture

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2
Q

Signs and Symptoms of Acetabular Fracture

A

Pain over the hip area

Deformity depending on the mechanism of injury and degree of fracture displacement

Contusion and hematoma over the area affected

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3
Q

Sciatic nerve palsy-most common
Hemodynamic instability
Superior gluteal artery or vein may be injured by the fracture at the greater sciatic notch
Heterotrophic ossification especially after surgery
Avascular necrosis of the femoral head
Chondrolysis Post traumatic arthritis

A

Complications of Acetabular Fracture

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4
Q

Diagnosis of Acetabular Fracture

A

Radiographic x-ray (AP view of pelvis and hip, oblique view

CT scan

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5
Q

For minimally displaced and stable fracture

Skeletal traction 4-6 weeks

A

Conservative treatment for Acetabular Fracture

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6
Q

displaced and/or unstable fracture

A

Surgical treatment for Acetabular Fracture

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7
Q

Usually due to vehicular accidents or fall from height

A

Pelvic Fracture

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8
Q

Force is from anterior going posterior (force from front to back)

Pelvis spring open like a book, hanging on the posterior ligaments

A

Anteroposterior compression

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9
Q

Force is from one side of the pelvis (coming from side)

A

Lateral compression

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10
Q

Results in instability of the hemipelvis (like jump, vertical)

A

Vertical shear

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11
Q

After vigorous muscle contraction as in sports

Can affect iliac spine, ischium (hamstring), lesser trochanter (only a part is affected)

A

Avulsion fracture

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12
Q

Usually pubic rami due to fall from standing or seating position

A

Osteoporosis

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13
Q

stable (pelvic ring stable)

A

Type A Pelvic Fracture

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14
Q

rotationally unstable injury, vertically stable

A

Type B Pelvic Fracture

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15
Q

pelvic ring rotationally and vertically unstable

A

Type C Pelvic Fracture

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16
Q

Type A Pelvic Fracture

A

A1: fractures not involving the ring (i.e. avulsions, iliac wing, or crest fractures)
A2: stable minimally displaced fractures of the pelvic ring

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17
Q

Type B Pelvic Fracture

A

B1: open book
B2: lateral compression, ipsilateral
B3: lateral compression, contralateral, or bucket-handle type injury

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18
Q

Type C Pelvic Fracture

A

Dangerous because of the organs, and vessels in it that can be punctured.

C1: Unilateral
C2: Bilateral
C3: associated with acetabular fracture

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19
Q

Hemorrhage
Injury to the lumbosacral plexus and nerve roots
Bladder and urethral injuries
Bowel injuries
Infection
Deep venous thrombosis (one of the vein clotted and dilodged = sudden difficulty of patient: common cause of death in pelvic with pelvic fractures)
Malunion leading to chronic pain
Non union
High mortality rate (30-50% for open fracture, 10- 30% for close fracture)

A

Complications of Pelvic Fracture

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20
Q

Signs and symptoms of Pelvic Fracture

A

Pain over pelvic injury

Pain when stressing the pelvis in compression or distraction

Massive flank or buttock contusion with hematoma

Leg length discrepancy (do xray to see if there is fracture)

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21
Q

Signs and symptoms for Avulsions

A

Swelling over the involved area

Pain and tenderness of the involved area that is exacerbated by forceful contraction of involved muscle

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22
Q

Dx of Pelvic Fracture

A

X-ray

CT scan

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23
Q

Protected weight bearing, pain management, avulsion fractures are treated with rest and early mobilization

Type A and B

A

Conservative Treatment for Pelvic Fracture

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24
Q

External or internal fixation

Type C

A

Surgery Treatment for Pelvic Fracture

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25
Q

Can affect the following

Femoral head
Femoral neck
Intertrochanteric area

A

Femoral fracture

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26
Q

Usually occurs with dislocations of the hip

A

Femoral Head Fracture

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27
Q

Etiology of Femoral Head Fracture

A

Trauma

Fatigue fractures

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28
Q

In osteopenic patients or those starting a new exercise regimen

Called subchondral impaction or insufficiency fractures

A

Fatigue fractures

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29
Q

based on the location of the fracture and on the presence of associated fracture

A

Pipkin classification

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30
Q

Fx below fovea/ligamentum (small)

Does not involve the weight bearing portion of the femoral head

A

Type I Pipkin

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31
Q

Fx above fovea/ ligamentum (larger)

Involves the weight bearing portion of the femoral head

A

Type II Pipkin

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32
Q

Type I or II with associated femoral neck fx

High incidence of Avascular necrosis

A

Type III Pipkin

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33
Q

Type I or II with associated acetabular fx (usually posterior wall fracture)

A

Type IV Pipkin

34
Q

Indication for conservative treatment of Femoral Head Fractture

A

Pipkin 1
Undisplaced Pipkin II with < 1 mm step off
No interposed ligaments
Stable hip joint

34
Q

Reduction
- Acute dislocation
- Reduce hip dislocation within 6 hours

Touch down weight bearing within 4-6 weeks and restrict adduction and IR

A

Conservative Treatment for Femoral Head Fracture

35
Q

ORIF

Arthroplasty (replace hip)

A

Surgical treatment for Femoral Head Fracture

36
Q

Pipkin II with > 1mm step off

if performing removal of loose bodies in the joint
associated neck or acetabular fx (Pipkin type III and IV)

polytrauma (multiple trauma)

irreducible fracture-dislocation

Pipkin IV

A

Indications for ORIF

37
Q

Pipkin I, II (displaced), III, and IV in older patients
fractures that are significantly displaced, osteoporotic or comminuted

A

Indications for Arthroplasty (Hip replacement

38
Q

Common in osteoporotic elderly patients (because of ward’s area of the neck)

Can occur in younger individuals after high energy

A

Femoral Neck Fracture

39
Q

Etiology of Femoral Neck Fracture

A

Fall (especially in osteoporotic individuals)

Major trauma

40
Q

Classification of Femoral Neck Fracture

A

Garden Classification

41
Q

incomplete fracture

A

Type 1 Garden Classification

41
Q

complete but undisplaced fracture

A

Type 2 Garden Classification

42
Q

complete fracture with partial displacement

A

Type 3 Garden Classification

43
Q

complete fracture with complete displacement

A

Type 4 Garden Classification

44
Q

Pain

Involved extremity is shortened and externally rotated

Inability to ambulate or ambulates with a limp

Tenderness with percussion of the greater trochanter

A

Signs and Symptoms of femoral neck fracture

45
Q

Nonunion (after 6 months still did not unite)

Avascular necrosis

Infection

Deep venous thrombosis and pulmonary embolism

Mortality –14% to 50% in the first year

A

Complications of Femoral Neck Fracture

46
Q

Dx of Femoral NECK Fracture

A

X-ray – AP and lateral view

MRI

47
Q

For debilitated patient with high risk for mortality or patient who are nonambulatory with minimal discomfort

Must be mobilized from bed to wheelchair as soon as pain permits

Non-ambulatory for 6 wks

A

Conservative Treatment for Femoral Neck Fracture

48
Q

For young patients to prevent risk of avascular necrosis

May involve use of screws or joint (hip) replacement

A

Surgical treatment for Femoral Neck Fracture

49
Q

Usually involves older patient than those who sustain a femoral neck fracture (does not cause avascular necrosis because the blood supply to the trochanteric area come from nutrient artery)

A

Intertrochanteric Fracture

50
Q

Etiology of Intertrochanteric Fracture

A

Low energy injury such as fall

High energy injury
- Usually in young patients
- Motor vehicular accidents or fall from height

51
Q

Classification of Intertrochanteric Fracture

A

Evans Classification

52
Q

Varus collapse
Wound infection
Non-union (rare)
Avascular necrosis (rare–not common)
Mortality (30% in the first year)

A

Complications of Intertrochanteric Fracture

53
Q

Pain

Shortened limb in external rotation of fracture is displaced

Inability to ambulate

Tenderness to percussion on the greater trochanter
Ecchymosis

A

Signs and Symptoms of Intertrochanteric Fracture

54
Q

Dx of Intertrochanteric Fracture

A

X-ray

MRI or bone scan

55
Q

For patients with high risk for developing surgical complications

Traction and bed rest

A

Conservative treatment of Intertrochanteric Fracture

55
Q

Close or open reduction followed by internal fixator (ORIF)

A

Surgical treatment for Intertrochanteric Fracture

55
Q

Trochanteric and Subcapital Fracture

Position of the Foot

A

produce shortening and lateral rotation of the leg

56
Q

Trochanteric and Subcapital Fracture

Shortening due to the strong muscles of the thigh

A

rectus femoris, the adductor muscles, and the hamstring (loss of attachment causes leg to shorten)

57
Q

Trochanteric and Subcapital Fracture

Lateral rotation due to

A

distal fragment rotates (as seen with toes pointing outwards) because: gluteus maximus, piriformis, obturator internus, gemelli, and quadratus femoris

58
Q

Trochanteric and Subcapital Fracture

If there is femoral fracture

A

he hip is shortened and ER.

59
Q

to replace hip

Common procedure performed in cases of severe joint damage caused by arthritis, displaced femoral neck fractures, and avascular necrosis

A

Arthroplasty

60
Q

Pain relief
Restoring motion to a stiffened joint
Maintain stability
Ambulate the patient early

A

Goals of Arthroplasty

61
Q

3 types of Arthroplasty

A

Resectional Arthroplasty

Interpositional arthroplasty

Replacement Arthroplasty

62
Q

removal of a segment of bone from one or both surfaces of the joint

Leaves a gap of 2cm or more which is subsequently filled up with fibrous tissue

Motion is improved and pain relieved but stability diminished

E.g Girdlestone excision (Floating Hip) for severe chronic infection

A

Resectional Arthroplasty

63
Q

involves insertion of a substance like fascia, skin, plastic or metal between the two reconstructed joint surfaces

Only offered limited success

A

Interpositional arthroplasty

64
Q

one or both joint surfaces are replaced by a prosthesis/implant made of metal, plastic or a combination

A

Replacement Arthroplasty

65
Q

2 types of Replacement Arthroplasty

A

Total hip and Partial hip arthroplasty (hemiarthroplasty)

66
Q

articular surfaces of femur and acetabulum is replaced (replace head and acetabulum)

A

Total hip arthroplasty

67
Q

replacement of the articular surface of the femoral head only (replaces head only)

A

Partial hip arthroplasty (hemiarthroplasty

68
Q

used in less active and older patients unlikely to outlive the hip implant

complication: predispose to acetabular erosion leading protrusio acetabuli

A

Unipolar hemiarthroplasty

69
Q

replacement of the head and the neck with an additional acetabular cup that is not attached to the pelvis

A

Bipolar hemiarthroplasty

70
Q

Types of arthroplasty fixation

A

Cemented

Cementless

71
Q

relies on bone growth into the prosthesis for fixation

Younger and active patients.

Cannot do weight bearing immediately

A

Cementless Fixation

71
Q

dislocation of the prosthesis

Fracture

Nerve impingement (Sciatic n.)

A

Complications of Arthroplasty

71
Q

No flexion beyond 90 degrees (not sit on low chair: will go beyond 90)

No abduction beyond 45 degrees

No adduction beyond midline

No rotation

A

dislocation of the prosthesis

72
Q

LCPD VS SCFE - Gender

A

Both Males

73
Q

LCPD VS SCFE - Age

A

LCPD - < 7 yo

SCFE - > 7 yo

74
Q

LCPD VS SCFE - Structure of Patient

A

LCPD - Thin

SCFE - Obese

75
Q

LCPD VS SCFE - Pathology

A

LCPD - Avascular necrosis

SCFE - Slipping of the femoral head at epiphysis

76
Q

LCPD VS SCFE - Treatment

A

LCPD - Braces (& traction)

SCFE - Traction

ms 1 - 2nd shift (13 decks)

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