DrCMoyoHip_fractures_for_MBChB_copy.pptx

An overview of Hip fractures

1. Hip Fractures and other conditions Dr P Mushayavanhu

2. Hip fractures Femoral head to 5cm below lesser trochanter Intracapsular vs extracapsular

3. Epidemiology Bimodal age distribution Low energy- old patients Whites > blacks Women > men High energy Young patients Most expensive fracture to treat on per person basis

4. Anatomy

5. Applied anatomy Intracapsular fracture High risk of femoral head avascular necrosis Extracapscular Will heal, rich blood supply

6. Risk factors Non modifiable Increasing age Female sex Family history of osteoporotic fractures Ethnic origin(Caucasians)

7. Risk factors Modifiable Low BMI Smoking Alcohol Low activity Secondary causes/comorbidities DM HIV Previous fracture

8. Risk factors Secondary factors Chronic kidney disease Chronic liver disease Spine injury Brain injury Depression Movement disorders Stroke Medication Steroids PPIs Antipsychotic medications

9. Risk factors Risk factors for falls vs Muscle weakness Abnormal gait or balance/neurological disorders Medications- sedative /cardiovascular side effects Poor sight Risk factors for change in bone mass

10. Clinical features Low energy fall, elderly women High energy in the young Repetitive loading for stress fractures Hip pain and inability to walk

11. Clinical features Associated injuries Cormobidities/ medication Lifestyle- alcohol/smoking

12. Clinical features Affected leg shorter Externally rotated Tender at the groin Hip motion painful Usually neurovascularly intact distally

13. Imaging X Rays AP Lateral Full length femur MRI/CT scan

14. Intracapsular Fracture Classification Anatomical Subcapital Transcervical Basicervical Garden Pauwels AO

15. Garden classification

16. Extracapsular fractures Pertrochanteric Subtrochanteric fractures Occur from between lesser trochanter & 5cm below it

17. Treatment Non operative vs operative Non operative Limited role High risk surgical patients with minimal pain

18. Treatment Intracapsular fractures Fix or replace Fix Udisplaced fractures Younger patients <65yrs

19. Options for fixation Cannulated screws Dynamic hip screw

20. Cannulated screws

21. Dynamic hip screw

22. Options for replacement Displaced fractures in the physiologically old >65 Hemiarthroplasty vs total hip arthroplasty Unipolar vs bipolar Hemiarthroplasty Limited role For the physiologically elderly patients

23. Austin Moore Prosthesis

24. Thompson Prosthesis

25. Bipolar Hemiarthroplasty

26. Total hip Arthroplasty

27. Extracapsular fractures Fix Role for non op Options DHS Intramedullary nail eg Cephalomedullary nail Fixed angled blade plate

28. Thank you