Hip Fracture Flashcards
Are there more hip fractures in men than women?
76% occur in women
What are hip fractures a result of?
90% of fractures
What is outcome of life for someone who has had a hip fracture?
1 in 5 individuals will die within 1year of injury
1 in 4 require nursing home care for at least 1 year
What is estimated cost of hip fractures?
$20 billion per year
How does risk of hip fracture increase?
risk doubles every 5 years after age of 50
Will survivors recover to functional status?
26%-75% fail to recover prior functional status within 1 year of injury
What does a presence of comorbitity affect your status?
increases mortality by approximately 16%
What are risk factors for hip fracture?
osteoporosis, gender, age, weight, height, race/ethinicity, smoking, physical activity, history of fracture after age 54, self reported health, parental hip fracture, cortiocosteroid use, treated diabetes
What are the types of intracapsular hip fractures?
involved femoral head or neck. higher rate of non-union and AVN
subcapital, transcervical, basicervical
What are types of extracapsular hip fractures?
involved trochanteric region.
trochanteric, intertrochanteric, subtrochanteric
What are the stages of hip fracture?
Stage 1: incomplete, may be impacted
Stage 2: complete, non-displaced
Stage 3: complete, partially displaced
Stage 4: complete, fully displaced
What are the three components of fracture management?
reduction
fixation
restoration of function
What are overall goals for fracture management?
Pain control
Reduction and fixation in good position
Return to function
Prevent complications
When is a conservative treatment used?
Unstable medical status
Non-displaced fractures
Risks of surgery vs. risks of immobility
What are consideration given if surgical treatment wants to be used?
ORIF vs. HA vs. THA
Considerations give to: Age, Mobility Status, Mental State, Pre-existing bone condition
Why is ORIF used?
It is bone conserving, possible lower mortality rate
What populations is ORIF indicated for?
Suggested for younger, highly active patients
Treatment of choice for extracapsular fractures
What is a disadvantage of ORIF?
higher failure rate (20-36%)
What are indications for a hemiarthroplasty?
intracapsular fracture
Why are hemiarthroplastys done?
appear to have better outcomes than ORIF
lower failure rate 6-18%
risk of dislocation 5%
How long will hemiarthroplastys last?
deterioration of function after 3-5 years
What are differences between unipolar and bipolar prosthesis?
Unipolar: femoral head articulates with acetabulum, but is fixed to stem
Bipolar: femoral head articulates with both acetabulum and stem
What are differences between cemented and non-cemented hips?
Some link bone cement with intra-operative morbidity
uncemented stems have been linked to greater pain and poorer overall function
When is total arthroplasty used?
intracapsular fracture
has acetabular component
often used to revise failed ORIF or HA
What are advantages of arthoplasty?
surgical skill is key
better outcomes than HA beyond 3 years
risk of dislocation 5-10%
What are the 2 surgical approaches?
Posterior: no adduction past neutral, no flexion past 90, no internal rotation; increased risk of dislocation, infection, DVT
Anterior: no abduction, no extension, no external rotation; increased operative time, blood loss, infection
What are complications of hip fracture surgery?
cardiovascular, pneumonia, pressure ulcers, delirium, UTI, wound infection, depression, malnutrition
What are never events?
UTI, ulcers, wound infection
What is single best predictor of operative mortality following hip fracture?
Delirium: a sign you have over taxed the system
Who gets delirium? When does it occur?
occurs 30-50% of post op patients
usually observed within POD 1-5, resolved by POD 7
What are two possibly lethal precautions of hip fracture surgery?
DVT: very common complication, up to 60% get it without prophylaxis, 20-30% get it with prophylaxis
PE: incidence 10-15%, mortality approx. 2-10%, accounts for 14% of deaths due to hip fractures
What is a crucial part of rehab?
Early mobilization
What is delayed mobilization associated with?
delirium pneumonia increased length of stay greater 6 month mortality poorer 2 month functional performance
How should you treat in acute stage?
1-7 days
general ROM, get joint moving, see how they tolerate movement, get them comfortable around you
What should you do in subacute/chronic stage?
> 7 days
can start more aggressive strengthening and exercises
What does it mean by “treating the cause”?
vast majority of fractures are due to falls
falls are leading cause of death in individuals greater than 65 years old
fall related injuries estimated to cost 54.9 billion by 2020
What are intrinsic risk factors for fall?
history of falls age/gender/ethnicity medical status medication impaired mobility sedentary lifestyle fear of falling impaired cognition visual impairment
What are extrinsic risk factors for falls?
environmental hazards
footware/clothing
inappropriate assistive device
