ortho complications important final.pptx

Ortho

1. Complications

2. Fracture of neck of femur Non-union Avascular necrosis Osteoarthritis

3. Non-union It occurs in 30-40% intracapsular fractures. Due to Inadequate immobilisation of fracture even with internal fixation. Poor blood supply of head of fracture. Patient presents with acute pain, inability to bear weight on the affected limb, external rotation of the limb and shortening of limb. On clinical examination Active straight leg raising is not possible. Trendelenburg's test will be positive. Diagnosis is made on X-ray or CT scan.

4. Treatment Beyond age of 60 years Younger individual Replacement arthroplasty Neck reconstruction by Baksi’s procedure Pauwel’s osteotomy

5. Baksi’s procedure Involves decompressing the necrotic area in the femoral head and then grafting a muscle pedicle (either the tensor fascia lata (TFL) or sartorius muscle along with a bone graft from the ilium) into a slot created in the femoral head to improve blood supply and promote healing. 

6. The procedure involves excision of wedge of bone from the lateral side of the femur (just below the greater trochanter).
The remaining femur is then fixed in a valgus (outward angulated) position.
Fixation is typically achieved using a double-angle blade plate or a dynamic hip screw (DHS) system.
Lateral displacement of the distal fragment and the intertrochanteric wedge can be used to correct leg length discrepancy and potentially increase neck length. Pauwel's osteotomy

7. Avascular necrosis After the fracture of neck of femur ,the medullary blood supply and the capsular blood supply to head are cut off. The viability of head of femur is dependent entirely on the blood supply through ligamentum teres. The insufficiency of this blood supply causes Avascular necrosis of the segment or whole of head. The avascular head may collapse and become deformed. These changes become evident only after few months to as long as 2 years. Diagnosis is made on X-rays and MRI.

8. Treatment Elderly patients Young patients Adult patients 1.Reconstruction by Meyer’s procedure 2.Replacement Total hip replacement Hemi-replacement arthroplasty

9. Meyer’s procedure The Meyers muscle pedicle graft involves utilizing a section of a muscle, often the quadratus femoris, along with a bone graft attached, to introduce a new blood supply to the femoral head and augment bone healing at the fracture site. This graft is surgically placed and secured at the fracture site to enhance healing 

10. Osteoarthritis Develops few years following fracture of neck of femur. Due to Avascular deformation of the head. Union in faulty alignment. Patient presents with pain and stiffness of the joint. Treatment Young patients- intertrochanteric osteotomy or partial hip replacement. Elderly patients- Total hip replacement .

11. Intertrochanteric fracture Malunion Osteoarthritis

12. Malunion Malunion gives rise to coxa vara (Decreased femoral neck-shaft angle), shortening and leg in external rotation. Treatment Elderly- malunion causes limp while walking and shortening, compensation for this is by shoe raise. Young people- correction is achieved by an intertrochanteric osteotomy where the neck shaft angle is corrected and held in proper position by internal fixation devices.

13. Osteoarthritis Patient complains of pain and stiffness in the hip after a reasonably symptom free period following union of fracture. Diagnosis is made by X-ray. Treatment – Early stages- physiotherapy Later stages- trochanteric osteotomy (younger patient) total hip replacement (elderly patient).

14. Thank you