Q: What is the approx. incidence of hip fractures per year?
Q: What percent of hip fractures occur in women?
Q: 1 in ____ individuals die within 1 year of a hip fracture.
Q: 1 in _____ require nursing home care for at least 1 year.
Q: What percent of hip fractures result from falls?
Q: The risk of fracture ____________ every 5 years after the age of 50.
Q: The fracture rate of institutionalized individuals is _____x greater than those in the community.
Q: ________% of survivors fail to recover to prior functional status within 1 year of injury.
Q: Presence of a comorbidity increases mortality by ~____%.
Content: Intracapsular Hip Fracture (2)
1. Involve femoral head or neck
2. Higher rate of non-union and AVN
Content: 3 types of intracapsular fractures
1. Subcapital 2. Transcervical 3. Basicervical
Content: Extracapsular Hip Fracture (2)
1. Involve trochanteric region
2. Types trochanteric, intertrochanteric, subtrochanteric
Content: 4 Stages of the Garden Staging System
1 = incomplete, may be impacted
2 = complete, non-displaced
3 = complete, partially displaced
4 = complete, fully displaced
Q: Which stages of the Garden Staging System require surgery?
2-4, however, by the time we see them all the stages will look the same to us
Q: What are the steps in fracture management and which step involves PTs?
Steps: reduction, fixation, restoration of function PT = restoration of function
Content: 4 goals of fracture management
1. Pain control
2. Reduction and fixation in good position
3. Return to function
4. Prevent complications
Content: 3 indications for a conservative treatment plan for fracture management
1. Unstable medical status
2. Non-displaced fractures
3. Risk of surgery vs. risk of immobility
Content: 3 Surgical treatments for hip fracture
Q: What 4 factors should be considered when hip surgery is an option?
2. Mobility status
3. Mental state
4. Pre-existing bone and joint pathology
Q: ORIF or pinning is thought as _______ ___________.
Q: What is the failure rate of ORIF?
Q: What population is ORIF suggested for?
Younger, highly active pts
Q: ORIF is the treatment of choice for _______________ fracture.
Q: Hemiarthroplasty is considered for ______________ fracture.
T/F: ORIF appears to have better outcomes than HA.
False, flip it
Q: What is the failure rate of HA?
Q: What is the risk of dislocation with HA?
Q: With HA you see a deterioration of function after ______ years
T/F: With HA only the femoral component is replaced.
Term: Femoral head articulates with acetabulum, but is fixed to the stem
Term: Femoral head articulates with both acetabulum and stem
T/F: Bipolar replacements are better than unipolar replacements.
False, no evidence that one is better than the other
T/F: It is unclear whether cemented or uncemented is the superior approach.
Q: THA is considered for _______________ fracture
T/F: THA has better outcomes than HA beyond 3 years.
Q: What is the risk of dislocation for a THA?
T/F: THA is never used to revise a failed ORIF or HA.
Content: Posterior THA precautions (3)
1. No ADD past neutral
2. No flexion past 90
3. No IR
Content: Anterior THA precautions (3)
1. No ABD
2. No (excessive) extension
3. No ER
Q: What are the 3 risks associated with posterior THAs?
Q: What are the 3 risks associated with anterior THAs?
1. Increased operative time
2. Increased blood loss
Content: Complications of hip surgery (8)
3. Pressure ulcers
6. Wound infection
Q: What is the single best predictor of operative mortality following hip fracture?
Q: Acute delirium occurs in _________% of post-op pts.
Q: Delirium is usually observed within POD _____, resolved by POD ___.
Content: DVT (3)
1. Very common complication of hip fracture
2. Incidence of up to 60% w/o prophylaxis
3. Incidence of 20-30% w/prophylaxis
Content: PE (3)
1. Incidence ~10-15%
2. Mortality ~2-10%
3. Account for 14% of deaths due to hip fracture
Q: What is the key to rehab for hip fractures?
Q: Delayed mobilizaiton is associated with... (5)
3. Increased length of stay
4. Greater 6 mo. mortality
5. Poorer 2 mo functional performance
T/F: The vast majority (90%) of hip fractures occur due to trauma.
T/F: Falls are the leading cause of death in individuals greater than 65 years old.
Diagram: Risk factors for falls