Orthopedics Flashcards
What are the 3 Main group Hip fractures?
Proximal femur,distal femur and femoral shaft
What classification is given to the proximal fractures?
The garden classification
What is the garden classification Type 1?
It is where there is low complication rate, there is also minimal interference with blood flow and there’s no requirement of reduction but fixation with multiple screws and pins and plates
Also the fracture is incomplete and undisplaced and the femoral head is titled in a vagus position
What is the garden classification Type 2 ?
It’s the same as the type one but the only difference is that it is a complete displaced fracture
What is the garden classification Type 3?
It is a complete and displaced fractures with some continuation between fractures ends
What is the garden classification Type 4?
It is a complete and displaced fracture with no continuation of fracture ends also has a high complication rate which could lead to non union and avascular necrosis and loss of blood supply to femoral head
What treatment is done to a type 3 graden fracture?
Reduction and internal fixation with sliding screw plate and pins and if there’s manipulative Reduction then treat as for type 4
What treatment is done with type 4 garden fracture?
In young fit patients- Reduction and internal fixation with a sliding screw plate and pins and if manipulative reduction fails the ORIF is to be done
In older patients- There should have surgery done but rather hemi athroplasty( Moores Prosthesis) because there’s a high rate of non union
What are the indication for Moores Prosthesis?
In patients with Rheumatoid disease and minimal athrutis of hip
And also patients with failure of closed reduction of a displaced intracapsular fracture
What are the diffrent types of surgical approaches that may be used to insert hemi athroplasty?
Posterior approach
Anterior approach
Lateral approach
What is the Posterior approach?
When a hip is dislocated through flexion,addiction and internal rotation
The soft tissue(fascia,gluteals and capsule are exposed and vulnerable to the stress of sitting
So abduction pillow is placed between legs to prevent re-dislocation
What are the physiotherapy precautions for the posterior approach?
No combined hip flexion,addiction and internal rotation exercises in bed
Also slouch sitting and high sitting
Once drains are removed patient can feWB and fit TED stockings may be worn
Also no squatting 6 months after post opp
What is the physiotherapy precautions for lateral approach?
Legs should be kept in a neural position avoid adduction and abduction
Also hip and knee flexion is to be avoided
Legs may not be crossed
What is the anterior approach?
Patient is nursed in half lying position
And this happened due to extention,external rotation and abduction and anterior muscles are exposed and hip is vulnerable
What are the physiotherapy precautions with the anterior approach?
Avoid excessive hip extension when patient can walk
Also avoid bridging with bed pan but rather use sitting positing and lifting with monkey chains
What are extracapsular fractures?
So this is a common injury that occurs in the elderly usually Mal union occurs and not non union because the blood supply to he fragments is not disturbed and most complications are those related to prolonged immobilization
What treatment is done on extracpsular fractures?
Internal fixation to prevent Mal union and to ensure early mobilization and optimum fixation with Zimmer screw plate with compression
What are physiotherapy precautions with those who have extracapular fractures?
Avoid abduction beyond neural
Avoid excessive rotation-internal or external
If able to walk commence with PWB on walking frame (2nd post opp)
When walking turn towards the affected leg
What is a subtrochanteric fracture?
Usually a fracture that happens below the lesser trachanter cause by major trauma in young adults
Also severe local soft tissue injury to be expected
What is the treatment for a subtrachanteric?
It’s non operative but usually during bed rest patient tends to go into flexion and abduction because of pull on glute medius and minimus muscles along with the ilopsoas so a Thomas splint or skeletal traction
No sitting after gumming but half sitting can be done
No hip flexion there will be steering strain at fracture site which delays union
ORIF to prevent prolonged bed rest and Mal union
What are the physiotherapy precautions for subtrochentic fractures?
Assessment
Bed exercises keep heel on bed for knee and hip flexion
Avoid straight leg raising until.theres knee locking at quadriceps
When walking caution patient when getting out of bed
What are the causes of femoral shaft fractures?
Falling with foot anchored-spiral fracture
Direct blow -transverse fractures
Gunshot wound-comminuted fractures
What is the management for femoral shaft fractures?
Non operative in infants under 15kg
Gallows or Bryant traction may be used
Union is clinically obvious when baby turns to prone
Children over 2 years
Thomas splint and balanced skin traction and fracture is soundly united after 6-Weeks
Rehab will take another 3-4 weeks
In adults
Skeletal traction a Denham pin is used and inserted proximal tibia on lateral aspect to prevent injuring peroneal nerve
Thomas splint is used with balanced or fixed traction
When fracture is healed 6 weeks after leg can be placed in a cast with crutches
What are intra-medullary implants ?
AO nails,Multiple Enders nails,Kutcher nails
