Download HIP FRACTURES

HIP FRACTURES
BY: RANDY BONNELL
BACKGROUND
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Fractures of the hip are relatively common in
adults and often lead to devastating
consequences
Disability frequently results from persistent pain
and limited physical mobility. Hip fractures are
associated with substantial morbidity and
mortality; approximately 15-20% of patients die
within 1 year of fracture.
Most hip fractures occur in elderly individuals as a
result of minimal trauma, such as a fall from
standing height
PATHOPHYSIOLOGY
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The hip joint is a large
multiaxial ball-and-socket
synovial joint, enclosed by a
thick articular capsule
During standing, the entire
weight of the upper body is
transmitted to the heads and
necks of the femurs.
The hip joint is further
supported by the femur and
the muscles that cross the
joint; this bone and these
muscles are the largest and
most powerful in the human
body.
Classifying fractures
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Femoral head fractures
Isolated femoral head
fractures are rare and are
usually associated with hip
dislocations. Superior
femoral head fractures
normally are associated
with anterior dislocations,
while inferior femoral head
fractures are associated
with posterior dislocations.
Femoral neck fractures
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These are rare among
younger patients but are
commonly seen in older
adults, most often
secondary to osteoporosis
or osteomalacia. These
fractures usually result
from minor trauma with
falls accounting for 90%,
or torsion.
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Type 1 - Stress fractures
or incomplete fractures
Type 2 - Impacted
fractures
Type 3 - Partially
displaced fractures
Type 4 - Completely
displaced or comminuted
fractures
Femoral neck fractures
PICTURES
Trochanteric fractures
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Greater trochanteric
fractures usually result
from avulsion injuries at
the insertion of the gluteus
medius. Lesser
trochanteric fractures may
be caused by avulsion
injuries of the iliopsoas
secondary to forceful
contraction. These are
most common in children
and young athletes (eg,
dancers, gymnasts).
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Type 1 - Nondisplaced
fractures
Intertrochanteric fractures
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These extracapsular
fractures occur in a
line between the
greater and lesser
trochanters, generally
in elderly patients and
women secondary to
osteoporosis.
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Type 1 - Single
fracture line without
displacement;
Frequency
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In the US: In the United States, hip fracture
occurs in approximately 80 per 100,000 persons
or approximately 250,000 persons each year. The
rate of hip fracture increases with age, doubling
each decade after age 50 years. Nearly half of all
hip fractures occur in adults older than 80 years.
Hip fracture at a young age is rare and is usually
the result of a high-velocity injury or, rarely,
secondary to bone pathology.
Mortality/Morbidity
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Reported overall mortality rate of hip
fractures is 15-20%, yet in older persons
this can increase to 36% over the year
following hip fracture. Rate of mortality is
greatest in the first few months following
injury but remains high for up to 1 year.
Morbidity associated with hip fracture is
staggering, especially in older persons.
Morbidity from immobilization includes
development of deep vein thrombosis,
pulmonary embolism, pneumonia, and
muscular deconditioning. Morbidity from
surgical procedures includes complications
of anesthesia, postoperative infection, loss
of fixation, malunion or nonunion, as well as
the complications associated with
immobilization as outlined above
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Hip fracture resulting from major trauma
often is associated with other bone and softtissue injuries, intra-abdominal and
intrapelvic injuries, major blood loss, head
and neck injuries, and other extremity
injuries. Morbidity associated with an
inability to return to a prefracture level of
mobility results in a loss of independence,
reduction in quality of life, and depression,
particularly in older persons.
Race /Sex
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The incidence of hip fracture is 2-3 times
greater in whites than in nonwhites,
primarily because of the increased rate of
osteoporosis in whites.
Rate of hip fracture is 2-3 times greater in
women than in men. At least 75% of all hip
fractures occur in women.
History
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In elderly patients, hip
fracture most often results
from a simple fall; in a
small percentage, it occurs
spontaneously, in the
absence of any trauma.
Patient complains of pain
and inability to move the
hip
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With stress fractures in
young athletes and
nondisplaced fractures,
patient may complain of
pain in hip or knee and
may be ambulatory.
Patient may have a history
of other osteoporotic
fractures, such as Colles
or vertebral compression
fractures
Physical
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Pay particular attention to vital
signs and secondary
manifestations of shock such
as changes in skin, mental
status, and urine output. Hip
fractures are associated with
blood volume losses of up to
1500 mL.
Inspect and palpate for
deformity, hematoma
formation, laceration, and
asymmetry
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Observe the anatomical
position of the extremity
because this alone provides
useful clues to the type of
injury the patient has
sustained.
If the patient is a trauma
victim, assess for pelvic
fractures by stressing the
pelvis anteriorly to posteriorly
through iliac crests and
symphysis pubis, and laterally
to medially through iliac crests.
Causes
Neurological
impairment
Caucasian
race
Cigarette
smoking
Institutional
living
Maternal
history of hip
fracture
Previous hip
fracture
Physical
inactivity
Tall stature
Alcohol
abuse
Low body
weight
Impaired
vision
Prolonged
corticosteroid
use
Use of
medications
that decrease
bone mass,
including
furosemide,
thyroid
hormone,
THE
NUMBER 1
REASON
IS…..
TREATMENT
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patient who complains of hip
pain should include
immobilization on a stretcher
If fracture or deformity of the
femur is obvious, apply a
traction splint and place an
intravenous (IV) line for
hydration
If the patient is hypotensive or
tachycardic, initiate crystalloid
fluid bolus and place patient
on supplemental oxygen
Initiate appropriate parenteral
analgesia as soon as possible
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Properly evaluate the entire
patient to rule out associated
severe injuries.
Stable and unstable fractures
usually are treated with ORIF
unless the patient is not an
operative candidate for other
reasons
Orthopedic surgery; vascular
surgery or neurology, if
necessary
MEDICATION /Analgesics
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Morphine sulfate
Fentanyl citrate
(Duragesic, Sublimaze
Antibiotics
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Cefazolin (Ancef, Kefzol, Zolicef
Gentamicin (Gentacidin, Garamycin
Ampicillin (Omnipen, Marcillin)
Vancomycin (Vancocin) --
Complications
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Infection
Nonunion
Avascular necrosis
Chronic pain
Gait disturbance
Patient Education
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Gear patient education
toward identification of
avoidable risk factors in
the patient's life.
In young persons, stress
avoidance of tobacco and
alcohol abuse and safe,
responsible use of
motorized vehicles
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Counsel older persons on
ways to make their home
environment safe from
falls. Encourage them to
consult with their primary
physician regarding
medications or
supplements for the
prevention and treatment
of osteoporosis.
Teach hip percautions
Hip Precautions