Geriatric hip fractures Flashcards
Risk factors for hip fractures in the elderly
- Osteoporosis
- falls
Explain osteoporosis as a risk factor for hip fractures
- Age/race
- body frame
- family hixtory
- medications
- reduced GI absorption of Ca
- decreased bone mineral density causes it to fracture more easily
Explain falls as a risk factor for hip fractures
- muscle strength loss
- slowed reflex reaction time
- vision problems
- medication/metabolism
- *sometimes elderly patients need their med dosage readjusted
Hip fracture classifications
types
- femoral neck
- intertrochanteric
- subtrochanteric
- look at picture
Femoral neck fractures
subtypes
- nondisplaced: incomplete or impacted fx; complete w/o displacement
- Displaced: complete with parital displacement; complete with full displacement
- displaced disrupts the cortex of the bone
Femoral head blood supply
- femoral artery: profunda femoris
- medial and lateral circumflex artery
- multiple ascending branches along femoral neck that may be disrupted with a fracture
Treatment for non-displaced femoral neck fractures
- intra and extra-osseous blood supplies should be intact
- usues in-situ pinning
- cannulated screws
- inverted triangle orientation
Treatment for displaced femoral neck fractures
- blood supply is disrupted
- osteoporosis may be a condition
- chronic medial problems
- hemiarthroplasty
advantages of hemiarthroplasty
for a femoral neck fracture
- immedate WBAT
- elderly maybe unable to comply with WB restrictions
- fracture is eliminated
- minimizes down time
- may wear down the articular cartilage of the socket
femoral neck fractures: complications
- osteonecrosis
- non-union
Femoral neck fractures
complications: osteonecrosis
- blood supply is interrupted
- necrosis/femoral head collapse
- typically more in displaced
- tx: re-operation with prosthetic replacement
can cause pain 6months - 1 year
Femoral neck fracutres
Complications: non-union
- fracture does not heal
- displaced fx (10-30%)
- re-operation necessary: typically prosthetic replacement but sometimes ORIF
Intertrochanteric hip fractures
subtypes
- stable: nondisplaced w/o comminution or displaced with minimal comminution
- unstable: displaced extensive posteromedial comminution or 3 subtrochanteric extension
Intertrochanteric hip fractures
treatment
- stale and unstable fx
- cephalomedullary IM nails (biomechanically better)
- compression screws can also be used
Intertrochanteric hip fractures
trochanteric fixation nail
- IM approach to proximal femur
- indications for short nail:
- *stable and unstable fx
- peritochanteric
- intertrochanteric
- basilar neck fx
- cominations of above*
- Alternative to: sliding hip screws-side plate device
Subtrochanteric hip fractures
Classifcation
- how many pieces/extent of the fx
Subtrochanteric hip fractures
description
- primarily cortical bone vs cancellous: slower healing
- stronger muscule forces on displaced fx (abductors)
- highest implant stresses (implant fx/failure)
- biomechanisally sound implants nescessary
Subtrochanteric hip fractures
surgical treatment
- long trochanteric fixation nail
- indications for ong IM nail;
- *sub-torchanteric fx
- proximal fx, assoicated with shoft fx
- pathological fx*
Advantages:
- percutaneous incision/insertion
- decreased blood loss and tissue trauma
- biomechanically strong implant
- immediate WBAT
General considertions
with hip fracture patients
- pain control: may have decreased tolerance to meds, avoid over sedation
- respiratory depression
- disorientation
- IV hydration pre-op
- foley monitor volume, concentration, color, avoid bed pain, pain, keep perineum dry
In patient post-op care considerations
- leg postion: pillow under knee and ankle, slight hip and knee flexion to relax muscules
- DVT prophylaxsis
- Operative dressing
- mobilized ASAP
- nausea, Vomiting, Constipation
- nasal oxygen and nutritional supplements
Geriatric hip fx red flags
- severe pain (pain should get better with healing)
- inability to move limb
- shorted, externally rotated LE or change
