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PTRS 746 > Hip Fracture > Flashcards

Flashcards in Hip Fracture Deck (38):
1

Are there more hip fractures in men than women?

76% occur in women

2

What are hip fractures a result of?

90% of fractures

3

What is outcome of life for someone who has had a hip fracture?

1 in 5 individuals will die within 1year of injury
1 in 4 require nursing home care for at least 1 year

4

What is estimated cost of hip fractures?

$20 billion per year

5

How does risk of hip fracture increase?

risk doubles every 5 years after age of 50

6

Will survivors recover to functional status?

26%-75% fail to recover prior functional status within 1 year of injury

7

What does a presence of comorbitity affect your status?

increases mortality by approximately 16%

8

What are risk factors for hip fracture?

osteoporosis, gender, age, weight, height, race/ethinicity, smoking, physical activity, history of fracture after age 54, self reported health, parental hip fracture, cortiocosteroid use, treated diabetes

9

What are the types of intracapsular hip fractures?

involved femoral head or neck. higher rate of non-union and AVN
subcapital, transcervical, basicervical

10

What are types of extracapsular hip fractures?

involved trochanteric region.
trochanteric, intertrochanteric, subtrochanteric

11

What are the stages of hip fracture?

Stage 1: incomplete, may be impacted
Stage 2: complete, non-displaced
Stage 3: complete, partially displaced
Stage 4: complete, fully displaced

12

What are the three components of fracture management?

reduction
fixation
restoration of function

13

What are overall goals for fracture management?

Pain control
Reduction and fixation in good position
Return to function
Prevent complications

14

When is a conservative treatment used?

Unstable medical status
Non-displaced fractures
Risks of surgery vs. risks of immobility

15

What are consideration given if surgical treatment wants to be used?

ORIF vs. HA vs. THA
Considerations give to: Age, Mobility Status, Mental State, Pre-existing bone condition

16

Why is ORIF used?

It is bone conserving, possible lower mortality rate

17

What populations is ORIF indicated for?

Suggested for younger, highly active patients
Treatment of choice for extracapsular fractures

18

What is a disadvantage of ORIF?

higher failure rate (20-36%)

19

What are indications for a hemiarthroplasty?

intracapsular fracture

20

Why are hemiarthroplastys done?

appear to have better outcomes than ORIF
lower failure rate 6-18%
risk of dislocation 5%

21

How long will hemiarthroplastys last?

deterioration of function after 3-5 years

22

What are differences between unipolar and bipolar prosthesis?

Unipolar: femoral head articulates with acetabulum, but is fixed to stem
Bipolar: femoral head articulates with both acetabulum and stem

23

What are differences between cemented and non-cemented hips?

Some link bone cement with intra-operative morbidity
uncemented stems have been linked to greater pain and poorer overall function

24

When is total arthroplasty used?

intracapsular fracture
has acetabular component
often used to revise failed ORIF or HA

25

What are advantages of arthoplasty?

surgical skill is key
better outcomes than HA beyond 3 years
risk of dislocation 5-10%

26

What are the 2 surgical approaches?

Posterior: no adduction past neutral, no flexion past 90, no internal rotation; increased risk of dislocation, infection, DVT
Anterior: no abduction, no extension, no external rotation; increased operative time, blood loss, infection

27

What are complications of hip fracture surgery?

cardiovascular, pneumonia, pressure ulcers, delirium, UTI, wound infection, depression, malnutrition

28

What are never events?

UTI, ulcers, wound infection

29

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

Delirium: a sign you have over taxed the system

30

Who gets delirium? When does it occur?

occurs 30-50% of post op patients
usually observed within POD 1-5, resolved by POD 7

31

What are two possibly lethal precautions of hip fracture surgery?

DVT: very common complication, up to 60% get it without prophylaxis, 20-30% get it with prophylaxis
PE: incidence 10-15%, mortality approx. 2-10%, accounts for 14% of deaths due to hip fractures

32

What is a crucial part of rehab?

Early mobilization

33

What is delayed mobilization associated with?

delirium
pneumonia
increased length of stay
greater 6 month mortality
poorer 2 month functional performance

34

How should you treat in acute stage?

1-7 days
general ROM, get joint moving, see how they tolerate movement, get them comfortable around you

35

What should you do in subacute/chronic stage?

>7 days
can start more aggressive strengthening and exercises

36

What does it mean by "treating the cause"?

vast majority of fractures are due to falls
falls are leading cause of death in individuals greater than 65 years old
fall related injuries estimated to cost 54.9 billion by 2020

37

What are intrinsic risk factors for fall?

history of falls
age/gender/ethnicity
medical status
medication
impaired mobility
sedentary lifestyle
fear of falling
impaired cognition
visual impairment

38

What are extrinsic risk factors for falls?

environmental hazards
footware/clothing
inappropriate assistive device