Hip Fracture Flashcards
Hip Fracture Risk Factors (12)
- Osteoporosis
- Female gender
- Age 50+
- Weight/Height
- Ethnicity (african americans/asians)
- Smoking
- Physical activity level
- History of fracture after age 54
- Co-morbidities
- Parental hip fracture
- Corticosteroid use
- Diabetes
Hip Fracture Presentation
Hip, leg and foot are externally rotated
Hip Fracture Types (2)
- Intracapsular
- Extracapsular
Intracapsular Hip Fractures (4)
- Occur within the joint capsule
- Occur on the femoral head/neck
- Prone to AVN/non-union
- Subcapital, transcervical, basicervical
Extracapsular Hip Fractures (3)
- Occurs outside the joint capsule
- Involves the trochanteric regions
- Trochanteric, intertrochanteric, subtrochanteric
Garden Hip Fracture Stages (4)
- Incomplete fracture, possibly impacted
- Complete fracture, no displacement
- Complete fracture, partial displacement
- Complete fracture, full displacement
Hip Fracture Goals (4)
- Pain management
- Reduction/fixation in good position
- Return to function
- Prevent complications
When is conservative (non-surgical) treatment of hip fracture indicated? (3)
- Patient has unstable medical status
- Fracture is not displaced
- Risks of surgery outweigh risks of being immobilized (i.e. patient might die on the table)
Surgical Treatment of Hip Fracture Considerations (5)
- ORIF vs. HA vs. THA
- Age
- Mobility status
- Mental state
- Pre-existing bone/joint pathology
What is ORIF (open reduction internal fixation)
- **Treatment of choice for extracapsular hip fractures
- Pinning, rods, nailing
- Often used in young active patients
What is HA (hemiarthroplasty)
- **Treatment for intracapsular hip fractures
- Replaced femoral head with prosthetic that is inserted into femoral shaft
- Unipolar or bipolar
HA Advantages (2)
- Better outcomes that ORIF
- Low failure rate
HA Disadvantages (2)
- Risk of dislocation
- Function decreases within 3-5 years
Describe a unipolar HA
Femoral head is fixated to the femoral neck; therefore, the prosthetic can only articulate with the acetabulum.
Describe a bipolar HA
Femoral head is not fixated to the femoral neck and can therefore articulate with the femoral neck and acetabulum.
ORIF Advantages (2)
- Conserves bone mass
- Lower mortality rates
ORIF Disadvantages
- Higher failure rate
Disadvantages to cementing (3)
- Linked to operation mortality
- Increases risk of infection
- May cause allergic reactions
Disadvantages to uncemented (2)
- Linked to increased pain
- Poorer functional level than cemented
What is THA (Total Hip Arthroplasty)
- **Considered for intracapsular fractures
- Surgery may be required or elective
- Often used to revise ORIF and HA interventions
THA Advantages
- Better outcomes after 3 years than HA
THA Disadvantages (3)
- Surgical skill of surgeon is key to success
- Risk of dislocation
- Least amount of bone conservation
Hip Surgical Approaches (2)
- Posterior
- Anterior
Posterior Surgical Disadvantages
- Increases risk for DVT, dislocation, and infection
Posterior Precautions (3)
- Adduction past neutral
- IR
- Flexion greater than 90 degrees
Anterior Surgical Disadvantages
- Increased operation time, blood loss, and infection
Anterior Precautions (3)
- Extension
- ER
- Abduction
General Hip Surgery Complications (9)
- Cardiovascular Stroke
- DVT/PE
- Pneumonia
- Pressure ulcers
- Delirium
- UTI
- Wound infection
- Depression
- Malnutrition
What is the best predictor of post-op mortality after hip fracture?
Delirium
What is delirium?
- Delirium is transient and AD is not
- Patients present with delusions, hallucinations, do not know time and place, incoherent speech, aimless physical activity, and wandering mind.
- Can be caused by drug overdose, fever, shock, anxiety, etc.
What is the first step in hip fracture rehab?
Early mobilization is crucial!!!
- Prevents delirium, pneumonia, decreases time of hospitalization, and increases level of function
What are the goals of acute stage rehab? (5)
- Days 1-7
- Focus on general ROM (be aware of hip precautions)
- Take time to get patient to trust you
- Do not overwhelm them
- May start some strength days 2-3
What are the goals of sub-acute/chronic stage rehab? (4)
- Day 7+
- Continue ROM, mobility
- Progress to strength, endurance and balance
- Fall prevention education
What is the largest cause of hip fracture?
Falls
Intrinsic Fall Risk Factors (7)
- Issues within the patient (disease, medical history, cognition etc)
- History of falls
- age, gender, ethnicity
- Medical status/Medications
- Impaired mobility
- Fear of falling
- Impaired cognition/vision
Extrinsic Fall Risk Factors (3)
- Environmental factors
- Footwear/clothing
- Inappropriate assistive devices
What did the hip fracture article say would help post-op hip fracture patients obtain better outcomes? (6)
- Heavy prophylaxis use to prevent DVT/PE
- Pain management
- Delirium prevention strategies
- Nutritional supplementation (prevent anemia)
- Physical therapy rehab
- Fracture re-occurrence prevention training
Match the hip fractures (intracapsular, extracapsular) with its treatment of choice (ORIF, HA, THA).
ORIF - extracapsular
HA - intracapsular
THA - intracapsular, esp when revising ORIF/HA
_____% of patients will develop a DVT w/out prophylaxis while ______% of patients develop a DVT w/ prophylaxis treatment after hip fracture surgery.
60%, 20-30%
Explain why people with very low and very high BMI are at higher risk for hip fracture.
- People with low BMI do not have any mass to protect their bones when they fall (straight contact of bone/hard surfaces).
- People with high BMI put more stress on the hip joints.
Women seem to be at more risk for hip fracture, explain why. (2)
- Live longer
- More likely to get osteoporosis
T/F: The risk for hip fracture triples every 5 years after age 45.
False, doubles every 5 yrs after 50
T/F: Intracapsular hip fractures are at a higher risk for AVN/non-union compared to extracapsular.
True
According to the Garden Staging System, what stages of fracture are most likely to be treated conservatively? Which stages are most likely to be treated surgically?
- Conservative = Stage 1
- Surgical = Stages 2-4
