HIp Fractures Flashcards
Hallmark of Hip Fx
GROIN PAIN
Presentation of hip fx
thigh or knee pain - obturator n.
may or may not be able to bear weight
limb deformities - shortened and externally rotated
PE can make the fx worse - traversing from the intertrochanteric region toward the head might indicate more intense tx modality
Log roll test
Dx of hip fx
GENTLY internally and externally rotate the leg - pain = positive = hip fx
Tx of hip fx
depends on the fx relative to the joint capsule
Intracapsular hip fx
all fx of the femoral neck
a. capital
b. subcapital- UNDER THE HEAD OF FEMUR
c. transvervical - across the neck of the femur
d. basicervical (baseo f the neck) - border of neck and intertrochanteric line
extracapsular hip fx
basicervical
intertrochanteric- intertrochanteric line
subtrochanteric - in the proximal shaft
fx of the femoral head
gun shot wound
high energy trauma
what are the ligaments of the capsule?
iliofemoral ligament
pubofemoral ligament
ischiofemoral ligament
Radiographic evaluations of the hip fx
orthogonal hip XR
AP is easy to get
what is an occult hip fx?
can’t see the fx on XR
- do a MRI
Garden classification of hip fx
Type I - incomplete or valgus impacted
Type II - complete non-displaced
Type III - complete partially displaced
Type IV - complete and completely displaced
Tx of garden hip fx
depends on life or death of the femoral head
Tx of type I and II
in situ pinning
head will live, thank god
Tx of type III and IV
hemiarthroplasty - joint surface is replaced by artificial metal
medial circumflex is torn = AVN
conservative Tx intracapsular fx
rarely indicated unlike in osteoarthritis
PROLONGED BEST REST AND TRACTION
not the usual tx
Surgical tx of intracapsular fx
ORIF - open reduction and internal fixation
in situ pinning - percutaneous screw fixation for garden type I and II
hemiarthroplasty for garden type III and IV
hemiarthroplasty vs arthroplasty
hemiarthroplasty-
not putting it in the acetabular cup
patients are allowed to bear weight immediately after surgery
difference between hip fx vs femoral shaft fx
subtrochanteric fx falls in the shaft of the femur but it is considered part of the hip fx and not the femoral shaft fx
hip fx is defined uniquely
PROXIMAL FEMUR FX
not femoral shaft fx
not acetabular fx
Fixation of intertrochanteric fx
dynamic hip screw - a metal rod to side of the bone and nail it in
they will still have their bone/vasculature
-had intertrochanteric fx
cephalomedullary nail - IM Nail
rod right down the middle of the femur - sits on the lateral side of the bone and is nailed in from there - mechanical advantage with fixation closer to where load is
Tx of subtrochanteric fx
same as intertrocheric fx
with DHS and IM nail
it will not result in non-unions or AVN
DVT
big deal with any of the fx
require prophylaxis with low weight heparin
