Downloaded 69 times
More Related Content
Similar to Intra capsular neck of femur fractures
Intra capsular neck of femur fractures
- 1. Intra-capsular Neck Of FemurFractures Sheweidin AZIZ – Sep 2015
- 2. Aim 1. Background 2. Anatomy+ Patho-anatomy 3. Predisposing factors 4. Mechanism of injury 5. Clinical presentation/Radiological investigation 6. Classification 7. Aims of treatment 8. Management 9. Complications
- 3. Background About 70-75,000 hipfractures per year in UK (10/1000) Average age 77 years Commonest cause of admission to orthopaedic wards Usually fragility fracture
- 4. Background Lifetime risk 15%♀ and 5% ♂ High mortality rate ~10% in 30 days and up to30% in a year Annual cost of over £2 billion About 10-20% admitted from home will move to institutional care
- 5.
- 6. Anatomy Described by Crock Extra-capsularring Retinacular Ligamentun Teres
- 7.
- 8. Predisposing factors 1. Lossof bone strength 2. Loss of local shock absorbers 3. Reduction in protective responses 4. Increased risk of falls
- 9. Mechanism of injury LowEnergy Direct Indirect High Energy Cyclical Loading Stress fracture
- 10. Clinical Presentation History Injury Predisposing factors Inabilityto weight bear Clinical examination Shortening and external rotation Inability to SLR Groin tenderness
- 11.
- 12. Radiological investigations Plain radiograph(Antero-posterior and Lateral) MRI CT
- 18.
- 19.
- 20.
- 21.
- 22.
- 23. Goals of treatment Patientcomfort Restore hip function / independence Reduce length of immobility
- 24. Management - Multidisciplinaryteam 1. General 1. Identify +/- treat cause of injury 2. Secondary prevention 3. Rehabilitation 2. Specific 1. Management of hip fracture: Conservative/Operative
- 25. Specific management 1. Analgesia 2.Hydration 3. Investigations (Bloods, CXR, ECG, Echo .. etc) 4. Identify and treat co-morbidities to avoid delay
- 26. Operative management 1. InternalFixation 1. Cannulated screws 2. Dynamic Hip screws 2. Arthroplasty 1. Cemented Thompson 2. Cemented bipolar 3. Uncemented Austin Moore 4. Total hip Replacement
- 27.
- 28.
- 29.
- 30.
- 31.
- 32.
- 33. Complications - General VTE / PE Infections (UTI / LRTI / Wound) Bed sores Osteoarthritis Avscaulr necrosis Non union
- 34. Complications – Arthroplasty Revisionsurgery 10% Higher mortality Longer hospital stay Dislocation
- 35. Complications – Arthroplasty Leglength discrepancy Acetabular erosion Implant infection Fracture around prosthesis Expensive
- 36. Complications – InternalFixation Non union 20-30% Avascular necrosis 10-20% Revision surgery 25-30%
- 37. Post Operative care 1.Check Hb / U&Es 2. VTE prophylaxis 3. Rehabilitation with physio - Mobilise Full weight bearing 4. +/- check X-Rays
- 38. Further reading 1. OrthopaedicTrauma Association Classification 2. BOAST guidelines on Fragility Hip Fractures 3. National Hip Fracture Database 4. NICE clinical guidance – Management of hip fractures in adults
- 39.