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PTRS 746 Musculoskeletal > Hip Fracture > Flashcards

Hip Fracture Flashcards

1
Q

Hip Fracture Risk Factors (12)

A
  • Osteoporosis
  • Female gender
  • Age 50+
  • Weight/Height
  • Ethnicity (african americans/asians)
  • Smoking
  • Physical activity level
  • History of fracture after age 54
  • Co-morbidities
  • Parental hip fracture
  • Corticosteroid use
  • Diabetes
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2
Q

Hip Fracture Presentation

A

Hip, leg and foot are externally rotated

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3
Q

Hip Fracture Types (2)

A
  1. Intracapsular
  2. Extracapsular
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4
Q

Intracapsular Hip Fractures (4)

A
  • Occur within the joint capsule
  • Occur on the femoral head/neck
  • Prone to AVN/non-union
  • Subcapital, transcervical, basicervical
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5
Q

Extracapsular Hip Fractures (3)

A
  • Occurs outside the joint capsule
  • Involves the trochanteric regions
  • Trochanteric, intertrochanteric, subtrochanteric
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6
Q

Garden Hip Fracture Stages (4)

A
  1. Incomplete fracture, possibly impacted
  2. Complete fracture, no displacement
  3. Complete fracture, partial displacement
  4. Complete fracture, full displacement
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7
Q

Hip Fracture Goals (4)

A
  1. Pain management
  2. Reduction/fixation in good position
  3. Return to function
  4. Prevent complications
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8
Q

When is conservative (non-surgical) treatment of hip fracture indicated? (3)

A
  • Patient has unstable medical status
  • Fracture is not displaced
  • Risks of surgery outweigh risks of being immobilized (i.e. patient might die on the table)
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9
Q

Surgical Treatment of Hip Fracture Considerations (5)

A
  • ORIF vs. HA vs. THA
  • Age
  • Mobility status
  • Mental state
  • Pre-existing bone/joint pathology
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10
Q

What is ORIF (open reduction internal fixation)

A
  • **Treatment of choice for extracapsular hip fractures
  • Pinning, rods, nailing
  • Often used in young active patients
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11
Q

What is HA (hemiarthroplasty)

A
  • **Treatment for intracapsular hip fractures
  • Replaced femoral head with prosthetic that is inserted into femoral shaft
  • Unipolar or bipolar
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12
Q

HA Advantages (2)

A
  • Better outcomes that ORIF
  • Low failure rate
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13
Q

HA Disadvantages (2)

A
  • Risk of dislocation
  • Function decreases within 3-5 years
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14
Q

Describe a unipolar HA

A

Femoral head is fixated to the femoral neck; therefore, the prosthetic can only articulate with the acetabulum.

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15
Q

Describe a bipolar HA

A

Femoral head is not fixated to the femoral neck and can therefore articulate with the femoral neck and acetabulum.

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16
Q

ORIF Advantages (2)

A
  • Conserves bone mass
  • Lower mortality rates
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17
Q

ORIF Disadvantages

A
  • Higher failure rate
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18
Q

Disadvantages to cementing (3)

A
  • Linked to operation mortality
  • Increases risk of infection
  • May cause allergic reactions
19
Q

Disadvantages to uncemented (2)

A
  • Linked to increased pain
  • Poorer functional level than cemented
20
Q

What is THA (Total Hip Arthroplasty)

A
  • **Considered for intracapsular fractures
  • Surgery may be required or elective
  • Often used to revise ORIF and HA interventions
21
Q

THA Advantages

A
  • Better outcomes after 3 years than HA
22
Q

THA Disadvantages (3)

A
  • Surgical skill of surgeon is key to success
  • Risk of dislocation
  • Least amount of bone conservation
23
Q

Hip Surgical Approaches (2)

A
  • Posterior
  • Anterior
24
Q

Posterior Surgical Disadvantages

A
  • Increases risk for DVT, dislocation, and infection
25
Q

Posterior Precautions (3)

A
  • Adduction past neutral
  • IR
  • Flexion greater than 90 degrees
26
Q

Anterior Surgical Disadvantages

A
  • Increased operation time, blood loss, and infection
27
Q

Anterior Precautions (3)

A
  • Extension
  • ER
  • Abduction
28
Q

General Hip Surgery Complications (9)

A
  • Cardiovascular Stroke
  • DVT/PE
  • Pneumonia
  • Pressure ulcers
  • Delirium
  • UTI
  • Wound infection
  • Depression
  • Malnutrition
29
Q

What is the best predictor of post-op mortality after hip fracture?

A

Delirium

30
Q

What is delirium?

A
  • Delirium is transient and AD is not
  • Patients present with delusions, hallucinations, do not know time and place, incoherent speech, aimless physical activity, and wandering mind.
  • Can be caused by drug overdose, fever, shock, anxiety, etc.
31
Q

What is the first step in hip fracture rehab?

A

Early mobilization is crucial!!!

  • Prevents delirium, pneumonia, decreases time of hospitalization, and increases level of function
32
Q

What are the goals of acute stage rehab? (5)

A
  • Days 1-7
  • Focus on general ROM (be aware of hip precautions)
  • Take time to get patient to trust you
  • Do not overwhelm them
  • May start some strength days 2-3
33
Q

What are the goals of sub-acute/chronic stage rehab? (4)

A
  • Day 7+
  • Continue ROM, mobility
  • Progress to strength, endurance and balance
  • Fall prevention education
34
Q

What is the largest cause of hip fracture?

A

Falls

35
Q

Intrinsic Fall Risk Factors (7)

A
  • Issues within the patient (disease, medical history, cognition etc)
  • History of falls
  • age, gender, ethnicity
  • Medical status/Medications
  • Impaired mobility
  • Fear of falling
  • Impaired cognition/vision
36
Q

Extrinsic Fall Risk Factors (3)

A
  • Environmental factors
  • Footwear/clothing
  • Inappropriate assistive devices
37
Q

What did the hip fracture article say would help post-op hip fracture patients obtain better outcomes? (6)

A
  • Heavy prophylaxis use to prevent DVT/PE
  • Pain management
  • Delirium prevention strategies
  • Nutritional supplementation (prevent anemia)
  • Physical therapy rehab
  • Fracture re-occurrence prevention training
38
Q

Match the hip fractures (intracapsular, extracapsular) with its treatment of choice (ORIF, HA, THA).

A

ORIF - extracapsular

HA - intracapsular

THA - intracapsular, esp when revising ORIF/HA

39
Q

_____% of patients will develop a DVT w/out prophylaxis while ______% of patients develop a DVT w/ prophylaxis treatment after hip fracture surgery.

A

60%, 20-30%

40
Q

Explain why people with very low and very high BMI are at higher risk for hip fracture.

A
  • People with low BMI do not have any mass to protect their bones when they fall (straight contact of bone/hard surfaces).
  • People with high BMI put more stress on the hip joints.
41
Q

Women seem to be at more risk for hip fracture, explain why. (2)

A
  • Live longer
  • More likely to get osteoporosis
42
Q

T/F: The risk for hip fracture triples every 5 years after age 45.

A

False, doubles every 5 yrs after 50

43
Q

T/F: Intracapsular hip fractures are at a higher risk for AVN/non-union compared to extracapsular.

A

True

44
Q

According to the Garden Staging System, what stages of fracture are most likely to be treated conservatively? Which stages are most likely to be treated surgically?

A
  • Conservative = Stage 1
  • Surgical = Stages 2-4

PTRS 746 Musculoskeletal (9 decks)

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