Post on 15-Apr-2017
Aim1. Background2. Anatomy + Patho-anatomy3. Predisposing factors4. Mechanism of injury5. Clinical presentation/Radiological investigation6. Classification7. Aims of treatment 8. Management9. Complications
Background About 70-75,000 hip fractures per year in UK
(10/1000)
Average age 77 years
Commonest cause of admission to orthopaedic wards
Usually fragility fracture
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
Predisposing factors1. Loss of bone strength
2. Loss of local shock absorbers
3. Reduction in protective responses
4. Increased risk of falls
Clinical Presentation History
Injury Predisposing factors Inability to weight bear
Clinical examination Shortening and external rotation Inability to SLR Groin tenderness
Management - Multidisciplinary team1. General
1. Identify +/- treat cause of injury2. Secondary prevention3. Rehabilitation
2. Specific 1. Management of hip fracture:
Conservative/Operative
Specific management1. Analgesia
2. Hydration
3. Investigations (Bloods, CXR, ECG, Echo .. etc)
4. Identify and treat co-morbidities to avoid delay
Operative management1. Internal Fixation
1. Cannulated screws2. Dynamic Hip screws
2. Arthroplasty1. Cemented Thompson2. Cemented bipolar3. Uncemented Austin Moore4. Total hip Replacement
Complications - General VTE / PE
Infections (UTI / LRTI / Wound)
Bed sores
Osteoarthritis
Avscaulr necrosis
Non union
Complications – Arthroplasty Leg length discrepancy
Acetabular erosion
Implant infection
Fracture around prosthesis
Expensive
Complications – Internal Fixation
Non union 20-30%
Avascular necrosis 10-20%
Revision surgery 25-30%
Post Operative care1. Check Hb / U&Es
2. VTE prophylaxis
3. Rehabilitation with physio - Mobilise Full weight bearing
4. +/- check X-Rays
Further reading1. Orthopaedic Trauma Association Classification
2. BOAST guidelines on Fragility Hip Fractures
3. National Hip Fracture Database
4. NICE clinical guidance – Management of hip fractures in adults