Hip Fracture

Question 1

Q: What is the approx. incidence of hip fractures per year?

Answer 1

329,000`

Question 2

Q: What percent of hip fractures occur in women?

Answer 2

76

Question 3

Q: 1 in ____ individuals die within 1 year of a hip fracture.

Answer 3

5

Question 4

Q: 1 in _____ require nursing home care for at least 1 year.

Answer 4

4

Question 5

Q: What percent of hip fractures result from falls?

Answer 5

90

Question 6

Q: The risk of fracture ____________ every 5 years after the age of 50.

Answer 6

doubles

Question 7

Q: The fracture rate of institutionalized individuals is _____x greater than those in the community.

Answer 7

5-11

Question 8

Q: ________% of survivors fail to recover to prior functional status within 1 year of injury.

Answer 8

26-75

Question 9

Q: Presence of a comorbidity increases mortality by ~____%.

Answer 9

16

Question 10

Content: Intracapsular Hip Fracture (2)

Answer 10

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

Question 11

Content: 3 types of intracapsular fractures

Answer 11

1. Subcapital 2. Transcervical 3. Basicervical

Question 12

Content: Extracapsular Hip Fracture (2)

Answer 12

1. Involve trochanteric region
2. Types trochanteric, intertrochanteric, subtrochanteric

Question 13

Content: 4 Stages of the Garden Staging System

Answer 13

1 = incomplete, may be impacted

2 = complete, non-displaced

3 = complete, partially displaced

4 = complete, fully displaced

Question 14

Q: Which stages of the Garden Staging System require surgery?

Answer 14

2-4, however, by the time we see them all the stages will look the same to us

Question 15

Q: What are the steps in fracture management and which step involves PTs?

Answer 15

Steps: reduction, fixation, restoration of function PT = restoration of function

Question 16

Content: 4 goals of fracture management

Answer 16

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

Question 17

Content: 3 indications for a conservative treatment plan for fracture management

Answer 17

1. Unstable medical status
2. Non-displaced fractures
3. Risk of surgery vs. risk of immobility

Question 18

Content: 3 Surgical treatments for hip fracture

Answer 18

1. ORIF
2. HA
3. THA

Question 19

Q: What 4 factors should be considered when hip surgery is an option?

Answer 19

1. Age
2. Mobility status
3. Mental state
4. Pre-existing bone and joint pathology

Question 20

Q: ORIF or pinning is thought as _______ ___________.

Answer 20

bone conserving

Question 21

Q: What is the failure rate of ORIF?

Answer 21

20-36%

Question 22

Q: What population is ORIF suggested for?

Answer 22

Younger, highly active pts

Question 23

Q: ORIF is the treatment of choice for _______________ fracture.

Answer 23

Extracapsular

Question 24

Q: Hemiarthroplasty is considered for ______________ fracture.

Answer 24

Intracapsular

Question 25

T/F: ORIF appears to have better outcomes than HA.

Answer 25

False, flip it

Question 26

Q: What is the failure rate of HA?

Answer 26

6-18%

Question 27

Q: What is the risk of dislocation with HA?

Answer 27

~5%

Question 28

Q: With HA you see a deterioration of function after ______ years

Answer 28

3-5

Question 29

T/F: With HA only the femoral component is replaced.

Answer 29

True

Question 30

Term: Femoral head articulates with acetabulum, but is fixed to the stem

Answer 30

Unipolar

Question 31

Term: Femoral head articulates with both acetabulum and stem

Answer 31

Bipolar

Question 32

T/F: Bipolar replacements are better than unipolar replacements.

Answer 32

False, no evidence that one is better than the other

Question 33

T/F: It is unclear whether cemented or uncemented is the superior approach.

Answer 33

True

Question 34

Q: THA is considered for _______________ fracture

Answer 34

intracapsular

Question 35

T/F: THA has better outcomes than HA beyond 3 years.

Answer 35

True

Question 36

Q: What is the risk of dislocation for a THA?

Answer 36

5-10%

Question 37

T/F: THA is never used to revise a failed ORIF or HA.

Answer 37

False, often

Question 38

Content: Posterior THA precautions (3)

Answer 38

1. No ADD past neutral 2. No flexion past 90 3. No IR

Question 39

Content: Anterior THA precautions (3)

Answer 39

1. No ABD 2. No (excessive) extension 3. No ER

Question 40

Q: What are the 3 risks associated with posterior THAs?

Answer 40

1. Dislocation 2. Infection 3. DVT

Question 41

Q: What are the 3 risks associated with anterior THAs?

Answer 41

1. Increased operative time 2. Increased blood loss 3. Infection

Question 42

Content: Complications of hip surgery (8)

Answer 42

1. CV 2. Pneumonia 3. Pressure ulcers 4. Delirium 5. UTI 6. Wound infection 7. Depression 8. Malnutrition

Question 43

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

Answer 43

Delirium

Question 44

Q: Acute delirium occurs in \_\_\_\_\_\_\_\_\_% of post-op pts.

Answer 44

30-50

Question 45

Q: Delirium is usually observed within POD \_\_\_\_\_, resolved by POD \_\_\_.

Answer 45

1-5, 7

Question 46

Content: DVT (3)

Answer 46

1. Very common complication of hip fracture 2. Incidence of up to 60% w/o prophylaxis 3. Incidence of 20-30% w/prophylaxis

Question 47

Content: PE (3)

Answer 47

1. Incidence ~10-15% 2. Mortality ~2-10% 3. Account for 14% of deaths due to hip fracture

Question 48

Q: What is the key to rehab for hip fractures?

Answer 48

Early mobilization

Question 49

Q: Delayed mobilizaiton is associated with... (5)

Answer 49

1. Delirium 2. Pneumonia 3. Increased length of stay 4. Greater 6 mo. mortality 5. Poorer 2 mo functional performance

Question 50

T/F: The vast majority (90%) of hip fractures occur due to trauma.

Answer 50

False: falls

Question 51

T/F: Falls are the leading cause of death in individuals greater than 65 years old.

Answer 51

True

Question 52

Diagram: Risk factors for falls

Answer 52