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Hip fracture (proximal femur fracture) PowerPoint Presentation
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Hip fracture (proximal femur fracture)

Hip fracture (proximal femur fracture)

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Hip fracture (proximal femur fracture)

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  1. Hip fracture(proximal femur fracture)

  2. Risk factors • Increases with increasing age • > 50y/o, 2 times for each decade • Women: male 2.5: 1 • Urban dwelling,smoking,alcohol, caffeine,physical inactivity,psychotropic medication,senile dementia • Weight loss >10% (>50 y/o) • osteoporosis

  3. Mechanism A simple fall ( 90 %)

  4. Mortality • 1-year mortality: 12%-36% • High mortality within first 4-6 months after fracture • Higher mortality: advanced age,systemic dusease,male,institutionalized living,psychiatric illness • Delayed surgery: (> 2days) : doubled the mortality within first year

  5. Treatment principles • Early mobilization, prevent decubiti, atalectasis,UTI.thrombophlebitis • Surgery within 24 hours • To walk within 2 weeks after surgery

  6. Classification • Femeral neck fracture • Intertrochanteric fracture • Subtrochanteric fracture

  7. Anatomy • Blood supply: Ascending cervical branches of lateral and medial femoral circumflex artery , Arteries of ligamentum teres • Capsule: attached anteriorly at the intertrochanteric line; Posteriorly the lateral half of neck

  8. Femeral neck fracture

  9. General considerations • Intracapsular fracture • Not covered by periosteum; no callus formation • Endosteal healing

  10. Classification(Garden) • Non-displaced fractures Garden I: incomplete or impacted fracture Garden II: complete fracture without displacement • Displaced fractures Garden III: complete fracture with partial displacement Garden IV: complete fracture with total displacement

  11. Diagnosis Non-displaced and impacted fractures a.Pain with range of motion or percussion over the trochanter b. X-ray is often negative initially:tomograms orbone scan may be needed

  12. Diagnosis Displaced fractures a.Shortened or externally rotated extremity b.AP and lateral x-ray reveal changed neck-shaft angle

  13. Treatment Non-displaced fractures • Knowles pins or Cannulated screws • nonweight-bearing for 3 months

  14. Treatment Displaced fractures <60 years: Knowles pins or cannulated screws with or without vascular bone graft 60~80 years:Hemiarthroplasty with Bipolar prosthesis >80 years: Hemiarthroplasty with Austin-Moore prosthesis

  15. Complicationsnon-union and avascular necrosis

  16. Intertrochanteric fractures

  17. General considerations • Exuracapsular fracture with better healing potential • Age:10 years older than femoral neck fracture

  18. Classification(Boyd & Griffin) Stable fractures • Type I: Nondisplaced fracture • Type II: Displaced fracture Unstable fractures • Type III: Reverse,subtrochanteric,or posteromedial comminution fracture • Type IV: Intertrochanteric fracture with subtrochanteric fracture

  19. Stability of fracture • Integrity of the posteromedial cortex is the most important factor • Reverse fracture is more unstable • Subtrochanter fracture is more unstable

  20. Treament • Stable fractures: Close reduction with DHS(Dynamic hip screw) • Unstable fractures: Close reduction Gamma-nail(Small lever arm)

  21. Complications Less non-union or avascular necrosis Malunion happened in unstable fractures

  22. Thank you ( 3q )