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Published byAditya Pillsbury
Modified over 2 years ago
Re-written by: Daniel Habashi Intertrochanteric Hip Fractures
Intertrochanteric Hip Fracture objectives Incidence Mechanism of injury Physical findings X-ray assessment Classification scheme Treatment goals Treatment options Treatment techniques Complications Outcomes Failure of treatment Salvage procedures
Intertrochanteric femur From the extra-capsular femoral neck To inferior border of the lesser trochanter
Incidence 250K hip fractures a year Demographics 90% over 65 years of age F>M Peak around 80 y.
Etiology Osteoporosis Low energy fall – common High energy – rare
Prevention Prevention and active treatment of osteoporosis Fall prevention Minimize fall impact
Physical presentation Involved extremity Short External rotated
Radiographs Plain films AP pelvis Cross table lateral
Special studies CT scan rarely indicated Bone scan – occult fractures, sensitive at 72 hours MRI – occult fractures, sensitive in 1 st 24 hours
Classification Multiple classifications Stable vs. unstable Evans Evans-Jensen Muller AO/ASIF OTA Muller AO-ASIF system
Classification Stable Resists medial and compressive loads With anatomic reduction and fixation THERE WAS A PICTURE HERE OF A FRACTURE
OTA AO/ ASIF Classification 31-A3 Two part fracture Comminuting Fracture enters the lateral cortex Reverse obliquity fracture Unstable
OTA AO/ASIF Classification There was also 31-A2 but he changed the slide in a matter of a second so:/
Goals of treatment Obtain A stable reduction Internal fixation Good position Mechanically adequate Permit immediate transfers and early ambulation
Intra-operative positioning Hemilithotomy position
Intra-operative fluoroscopy 2 pictures of it. Nothing important
Fracture reduction Neck / shaft axial alignment Translational displacement Anatomic reduction of individual fragments is not necessary Reduction maneuver Traction Internal rotation
Implant options Compression hip screw and side plate Intramedullary sliding hip screw Calcar replacing prosthesis
Implant positioning Centered in the femoral head ( AP VIEW and LAT VIEW) Etc etc ect
Tip-apex distance (TAD) TAD – strong predictor of cut out TAD under 25mm Failure approaches zero TAD over 25mm Chance of failure increases rapidly
Implant options Intramedullary Sliding Hip Screw Decreased implant bending strain Potential percutaneus technique Inter-Troch Shaft Reverse obliquity Pathologic shaft fracture
Implant options Calcar replacing prosthesis Indications Ewtc etc etc
Reverse obliquity fracture
Cement augmentation Severe osteopenia Polymethyl methacrylate (PMMA) Improves screw purchase Augment deficient medial cortex Prevent screw cut out
Rehabilitation Mobilize Weight bearing as tolerated Etc. etc.etc.
Failed fixation Screw cut out Screw barrel disengagement
Salvage of failed fixation
Outcome Mortality 7-27% 3 months post-op # of medical problems # of post-op complications Function 40% pre-injury ambulatory status 40% ambulatory increased dependence 12% household ambulates 8% non ambulates
Femoral neck fractures
Traumatic conditions of the hip.. head neck lesser trochanter Obturator foramen ischium ilium pubis sacrum acetabulum greater trochanter ANTERIOR VIEW.
The ACETABULUM, HIP JOINT and Proximal FEMUR TRAUMA MI Zucker, MD.
MC, 26yo male Unrestrained driver Late night accident
Common Upper Limb Fractures By Chris Pullen.
Treatment of femoral neck fractures INTERNAL FIXATION –In biologic ‘young’ patients (< yr) ARTHROPLASTY –In biologic ‘old’ patients (> yr)
Lower Extremities Third Part Dr Mohamed El Safwany, MD.
Treatment of Subtrochanteric Fractures in Adolescent Patients with Reconstructive TAN Nail CHWO-London-ON-Canada Two Case Reports Khalil I Issa M.D Orthopedic.
Fracture of tibia ..
Acetabular fractures: the first three days.
Neck of Femur Fractures
H. Sithebe 1 Orthopaedics Department. FEMUR FRACTURES Femur Head Femur Neck Intertrochanteric Subtrochanteric Shaft Supracondylar Condylar 2.
Fracture neck Femur. Could be intracapsular or extracapsular Intracapsular # neck femur is notoriously known as an orthopedic enigma (difficult problem),
Tibial Plateau Fractures
Diaphyseal fractures in children Mohamed M. Zamzam Associate Professor & Consultant Pediatric Orthopedic Surgeon KKUH, Riyadh, Saudi Arabia.
X-Ray of the pelvis and lower limb
Fracture Neck Of Femur.
Get Hip to Hip Replacement By Anne Eby, RN Nursing made Incredibly Easy! May/June ANCC/AACN contact hours Online:
FRACTURES OF THE PROXIMAL HUMERUS Presented by Mahsa Mehdizade Dr. Mardani Porsina Hospital Spring 1392.
Femoral neck fractures Borrowed heavily from OTA core curriculum Authors: Steven A. Olson, MD and Brian Boyer, MD Kenneth J Koval, MD.
Thoraco-lumbar fractures Common injuries. 50% caused by MVA; rest by falls and sporting injuries. Commonly associated injuries; injuries at another level(10%-15%),
PELVIC INJURIES High energy trauma. May be life threatening. Road traffic accidents. Fall from height. Crush injuries.
Internal Fixation of Ankle Fractures
Failure of proximal femoral fracture managed by proximal femoral nail (PFN) leads to a very difficult situation to handle with conventional.
Joint Replacement Arthroplasty: Joint reconstruction
Fracture treatment A/ Reduce the fracture: Closed reduction Open reduction Articular fractures: Need anatomical reduction.
Fracture of the Femoral Shaft with Ipsilateral Fracture of the Femoral neck 박희곤ㆍ김명호ㆍ유문집ㆍ유현열ㆍ이대희 Dept. of Orthopaedic Surgery, Dankook University Hospital.
CF Rounds Mandible FRACTURES PRINCIPLES OF FIXATION April
Articular fractures Principles of management Ram K Shah Fractures Around Knee Joint: Femur, Tibia, Patella.
OSCE EXAM SIMULATION WITH THE IDEAL ANSWER second part
FRACTURES AROUND SHOULDER. Fractures around Shoulder Fractures of Clavicle Fractures of Scapula Fractures of proximal Humerus.
Sadeq Al-Mukhtar Consultant orthopaedic surgeon
Fractures general management. A high velocity injury should always be treated according to the Advanced Trauma Life Support (ATLS) guidelines with attention.
The Hip Fractures 林晉, MD, PhD 台大醫院骨科教授.
Fractures of the Acetabulum Dr Bakhtyar Baram. May be apart of alarger fracture in the pelvis or other regions like in the multitrauma pt.s. About 3/100.
Early Weight Bearing After Lower Extremity Fractures in Adults By.Dr samah sami nooh Resident in al hada arm forces hospital.
Supracondylar fractures of the femur Usually affect: Usually affect: 1. Young adults from high energy trauma. 2. Elderly osteoporotic persons.
Distal Third Femoral Shaft Fracture: Antegrade vs. Retrograde Nailing Michael Zlowodzki MD University of Minnesota Department of Orthopaedic Surgery.
Common adult fractures Axial skeleton (Pelvis) Waleed M. Awwad, MD. FRCSC Assistant professor and Consultant Orthopedic Surgery department.
Pediatric Intra-Articular Fracture Cases OTA RCFC 2.0 Presented by members of POSNA.
Treatment of Reverse Oblique and Transverse Intertrochanteric Fractures with Use of an Intramedullary Nail or a 95° Screw-Plate by Christophe Sadowski,
Femoral medialisation and functional outcome in trochanteric hip fractures Christopher Bretherton – Core Surgical Trainee Martyn Parker – Orthopaedic Consultant.
Format Short Cases A series of short questions Review of answers Discussions.
Case Examples An isolated injury in an adult, bicycle crash Treatment options?
Pelvic Ring Injuries Classification of Pelvic Ring Injuries
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