geriatric orthopedics Flashcards
those with increased risk of fall… (in terms of hip,knee, gait, age)
hip Increased flexion
knee: Decreased flexion in pre-swing, Decrease power in pre-swing
Gait: slow + Stride-to-stride variability
age: Frequency doubles every decade after 50
Decreased ________ function and loss of ______responses increase chance of falls
proprioceptive, protective
usual mechanism of hip fracture
Usually the femoral neck from twisting injury or the intertrochanteric region from fall on the greater trochanter
Elderly , Fall or sometimes mild trauma
Pain with walking and standing
Pain can radiate to the knee
what are we assuming…?
hip fx
PE hip fracture: pain where? changes in leg?
Pain in groin not laterally
May have externally rotated and shortened leg
If complaining of knee pain CHECK THE HIP!!!
imaging for hip fx: who gets imaging? why?
Chest x-ray if (+) for fracture: - OR clearance and possible fat embolism
CT/MRI for those who have history and exam consistent for fracture but negative plain films
3 types of hip fx surgery txts
- Open reduction internal fixation (ORIF): Nondisplaced or minimally displaced fx of femoral neck
- Hip Replacement: Displaced neck fractures
Have a high rate of vascular necrosis - Compression screw and side plate: Intertrochanteric fractures
why do we need people up and walking after hip surgery?
prevent blood clots
MOI:Falling on outstretched hand (FOOSH!)
what is the fracture?
Colle’s fracture
Distal radius fracture fragment is tilted dorsally
“dinner fork”
MOI:Falling on dorsum of hand
what is the fracture?
smith’s fracture
Distal segment is tilted volarly
txt for wrist fractures- accuracy of reduction correlates w/ what?
functional result
txt: displaced wrist fractures
Internal or external fixation
txt: minimally or nondisplaced
DONT need OR
Sugar tong splint 2-3 weeks then…
Short arm cast additional 2-3 weeks then…
Removable splint for 3 weeks
who gets vertebral compression fractures? what part of the spine is it usually?
elderly; Secondary to osteoporosis
Typically lower thoracic or upper lumbar (areas of most flexion of spine)
* Minimal trauma
what is a pathological fracture?
one secondary to a Dz process
what can compression fracture result in? painful?
Exaggerated thoracic kyphosis: “Dowager’s hump”
Caused by compression fractures and vertebral collapse; Can be very painful
compression spine fracture: conservative txt
Short-term pain medication and rest
Early mobilization and short term bracing
compression spine fracture: surgical txt - what indicates this txt?
for instability or neurological impairment
compression spine fracture: surgical txt. what is it? what can it improve?
Vertebroplasty/Kyphoplasty (percutaneously injecting cement into vertebral body to restore height)
Improve posture and pain
most common 2-part humerus fracture is where?
2-part is at surgical neck
PE of humerus fracture? (4)
Ecchymosis+ Swelling
Severe pain with movement (not so bad without movement)
Ask about numbness, tingling,
Check for pale extremities, radial pulse, capillary refill
Dx test common upper arm fractures:
Trauma series shoulder - minimum 3 views! …
AP
Axillary lateral view
Transscapular “Y” view
** Have to be sure not to miss a dislocation – do not accept suboptimal x-rays
common fracture txt: what kind of fractures would constitute a sling? what about prosthesis?
Usually for simple 2-part fractures at surgical neck sling is appropriate
For displaced 4-part fractures prosthesis secondary to disrupted blood supply
