Hip Fracture

Question 1

Are there more hip fractures in men than women?

Answer 1

76% occur in women

Question 2

What are hip fractures a result of?

Answer 2

90% of fractures

Question 3

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

Answer 3

1 in 5 individuals will die within 1year of injury

1 in 4 require nursing home care for at least 1 year

Question 4

What is estimated cost of hip fractures?

Answer 4

$20 billion per year

Question 5

How does risk of hip fracture increase?

Answer 5

risk doubles every 5 years after age of 50

Question 6

Will survivors recover to functional status?

Answer 6

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

Question 7

What does a presence of comorbitity affect your status?

Answer 7

increases mortality by approximately 16%

Question 8

What are risk factors for hip fracture?

Answer 8

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

Question 9

What are the types of intracapsular hip fractures?

Answer 9

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

Question 10

What are types of extracapsular hip fractures?

Answer 10

involved trochanteric region.

trochanteric, intertrochanteric, subtrochanteric

Question 11

What are the stages of hip fracture?

Answer 11

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

Question 12

What are the three components of fracture management?

Answer 12

reduction
fixation
restoration of function

Question 13

What are overall goals for fracture management?

Answer 13

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

Question 14

When is a conservative treatment used?

Answer 14

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

Question 15

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

Answer 15

ORIF vs. HA vs. THA

Considerations give to: Age, Mobility Status, Mental State, Pre-existing bone condition

Question 16

Why is ORIF used?

Answer 16

It is bone conserving, possible lower mortality rate

Question 17

What populations is ORIF indicated for?

Answer 17

Suggested for younger, highly active patients

Treatment of choice for extracapsular fractures

Question 18

What is a disadvantage of ORIF?

Answer 18

higher failure rate (20-36%)

Question 19

What are indications for a hemiarthroplasty?

Answer 19

intracapsular fracture

Question 20

Why are hemiarthroplastys done?

Answer 20

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

Question 21

How long will hemiarthroplastys last?

Answer 21

deterioration of function after 3-5 years

Question 22

What are differences between unipolar and bipolar prosthesis?

Answer 22

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

Question 23

What are differences between cemented and non-cemented hips?

Answer 23

Some link bone cement with intra-operative morbidity

uncemented stems have been linked to greater pain and poorer overall function

Question 24

When is total arthroplasty used?

Answer 24

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

Question 25

What are advantages of arthoplasty?

Answer 25

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

Question 26

What are the 2 surgical approaches?

Answer 26

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

Question 27

What are complications of hip fracture surgery?

Answer 27

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

Question 28

What are never events?

Answer 28

UTI, ulcers, wound infection

Question 29

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

Answer 29

Delirium: a sign you have over taxed the system

Question 30

Who gets delirium? When does it occur?

Answer 30

occurs 30-50% of post op patients

usually observed within POD 1-5, resolved by POD 7

Question 31

What are two possibly lethal precautions of hip fracture surgery?

Answer 31

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

Question 32

What is a crucial part of rehab?

Answer 32

Early mobilization

Question 33

What is delayed mobilization associated with?

Answer 33

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

Question 34

How should you treat in acute stage?

Answer 34

1-7 days

general ROM, get joint moving, see how they tolerate movement, get them comfortable around you

Question 35

What should you do in subacute/chronic stage?

Answer 35

> 7 days

can start more aggressive strengthening and exercises

Question 36

What does it mean by “treating the cause”?

Answer 36

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

Question 37

What are intrinsic risk factors for fall?

Answer 37

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

Question 38

What are extrinsic risk factors for falls?

Answer 38

environmental hazards
footware/clothing
inappropriate assistive device