Hip Fracture

Question 1

Risk Factors

Answer 1

Osteoporosis, Gender, Age, Obesity, Height, Race, Smoking, Physical Activity, Parental hip fracture, diabetes

Question 2

Types of Hip Fractures

Answer 2

Intracapsular and Extracapsular

Question 3

Intracapsular Fracture

Answer 3

1. Involve femoral head or neck
2. Higher rate of non-union and AVN
   - Subcapital, Transcervical, Basicervial

Question 4

Extracapsular Fracture

Answer 4

Involve trochanteric region

- Trochanteric, Intertrochanteric, Subtrochanteric

Question 5

Staging of Hip Fractures - Garden Staging System

Answer 5

Stage 1 - Incomplete, may be impacted
Stage 2 - Complete, non-displaced
Stage 3 - Complete, partially displaced
Stage 4 - Complete, fully displaced

Question 6

Fracture Management

Answer 6

Reduction, Fixation, Restoration of function

Question 7

Overall Goals

Answer 7

1. Pain control
2. Reduction and fixation in good position
3. Return to function
4. Prevent complications

Question 8

Conservative Treatment

Answer 8

1. Unstable medical status
2. Non-displaced fractures
3. Risks of surgery vs. risks of immobility

Question 9

Surgical Treatment

Answer 9

1. ORIF vs HA vs THA

2. Consideration given to: Age, Mobility Status, Mental State, Pre-existing bone and joint pathology

Question 10

ORIF (Open Reduction Internal Fixation, aka - pinning, nailing)

Answer 10

1. Bone conserving
2. Higher failure rate
3. Suggested for younger, highly active patients
4. Extracapsular fracture

Question 11

HA - Hemiarthroplasty

Answer 11

There is no acetabular component involved

1. Intracapsular fracture
2. Appear to have better outcomes than ORIF
3. Lower failure rate
4. Risk of dislocation
5. Deterioration of fxn after 3-5 years

Question 12

Unipolar Prosthesis

Answer 12

Femoral head articulates with acetabulum, but is fixed to stem

Question 13

Bipolar Prosthesis

Answer 13

Femoral head articulates with both acetabulum and stem

No evidence comparing uni vs. bi

Question 14

Cemented vs. Non-cemented

Answer 14

1. Possible intra-operative morbidity with cement

2. Uncemented stems have been linked to greater pain and poorer overall function

Question 15

THA - Total Hip Arthroplasty

Answer 15

1. Considered for intracapsular fracture
2. Surgical skill is key
3. Better outcomes than HA
4. Risk of dislocation

Question 16

Surgical Approach - Posterior - Precautions

Answer 16

No adduction past neutral, no flexion past 90, no IR

Increased risk of dislocation, infection, DVT

Question 17

Surgical Approach - Anterior - Precautions

Answer 17

No ER, no extension, no abduction

Increased operative time, mortality, blood loss, and infection

Question 18

What is the single best predictor of operative mortality following a hip fracture?

Answer 18

Delirium

Question 19

Delirium is usually resolved by _____ day

Answer 19

POD 7

Question 20

2 most common complications?

Answer 20

DVT and PE

Question 21

Delayed mobilization is associated with:

Answer 21

Delirium, Pneumonia, Increased length of stay, Greater 6 month morality, Poorer 2 month functional performance

Question 22

Treatment - Acute Stage

Answer 22

general ROM, how they tolerate movement

Question 23

Treatment - Subacute/Chronic Stages

Answer 23

Walking, Strengthening

Question 24

What is the biggest cause of hip fractures?

Answer 24

Falls (90%)