Hip Fracture/Hip Replacement n Causes of Falls n Hip anatomy –Intracapsular –Extracapsular n Ligaments n Intracapsular –capital –subcapital –basilar –transcervical n Extracapsular –Shortened, externally rotated, flexed, abducted –Strong abductors displace –Intertrochanteric
Intracapsular capital subcapital basilar transcervical Extracapsular Intertrochanteric
Hip Fracture/Hip Replacement n Blood supply –Medial circumflex –Lateral circumflex –Fovealar n Blood supply determines healing!
Initial Assessment for Hip Fracture n What factors should your assess? n What is Priority? n Treatment Options: –ORIF: pins, plates, screws –Femoral head replacement –Maybe total joint replacement n Pre-op Care
Post-op Care: ORIF/Joint Replacement n Post-op ORIF –Blood loss –Pain –Positioning –Tissue perfusion –Complications –Exercise
Repair of Hip Fractures; ORIF or Prosthesis Compare the nursing care of patient with joint prosthesis and Joint Replacement.
Total Hip n Types of Prosthesis n Pre-op Preparation n Intra-op considerations: approach, methylmethracrylate n Post-op Nursing Care: –Complications: blood loss –Neurovascular integrity –Potential dislocation: Prevent hip flexion, internal rotation –Weight bearing –Prevent DVT –Heterotrophic ossification
Keys to Care n Prevent dislocation! n Progressive activity n Prevent infection! Long term considerations n ? If little or no drainage post-op, what to do?
Discharge Instructions Total Hip n Do Not –Force hip more than 90 degrees –Force into adduction –No internal rotation –Put on own shoes, stockings for 8 wks n Do –Use elevated toilet seat –Sleep with pillow between legs for 1st. 8 wks –Keep hip neutral –Use prophylactic antibiotics –EXERCISE