PPT下載 - 台東醫院
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Transcript PPT下載 - 台東醫院
Hip fracture
(proximal femur fracture)
Risk factors
Increases
with increasing age
> 50y/o, 2 times for each decade
Women: male 2.5: 1
Urban dwelling,smoking,alcohol,
caffeine,physical inactivity,psychotropic
medication,senile dementia
Weight loss >10% (>50 y/o)
osteoporosis
Mechanism
A simple fall ( 90 %)
Mortality
1-year
mortality: 12%-36%
High mortality within first 4-6 months after
fracture
Higher mortality: advanced age,systemic
dusease,male,institutionalized living,psychiatric
illness
Delayed surgery: (> 2days) : doubled the mortality
within first year
Treatment principles
Early
mobilization, prevent decubiti,
atalectasis,UTI.thrombophlebitis
Surgery within 24 hours
To walk within 2 weeks after surgery
Classification
Femeral neck fracture
Intertrochanteric fracture
Subtrochanteric fracture
Anatomy
Blood
supply: Ascending cervical branches of
lateral and medial femoral circumflex artery ,
Arteries of ligamentum teres
Capsule: attached anteriorly at the intertrochanteric
line; Posteriorly the lateral half of neck
Femeral neck fracture
General considerations
Intracapsular
fracture
Not covered by periosteum;
no callus formation
Endosteal healing
Classification(Garden)
Non-displaced fractures
Garden I: incomplete or impacted fracture
Garden II: complete fracture without displacement
Displaced fractures
Garden III: complete fracture with partial displacement
Garden IV: complete fracture with total displacement
Diagnosis
Non-displaced and impacted fractures
a. Pain with range of motion or percussion
over the trochanter
b. X-ray is often negative initially:tomograms
or bone scan may be needed
Diagnosis
Displaced fractures
a. Shortened or externally rotated extremity
b. AP and lateral x-ray reveal changed
neck-shaft angle
Treatment
Non-displaced fractures
Knowles pins or Cannulated screws
nonweight-bearing for 3 months
Treatment
Displaced fractures
<60 years: Knowles pins or cannulated screws with
or without vascular bone graft
60~80 years:Hemiarthroplasty with Bipolar
prosthesis
>80 years: Hemiarthroplasty with Austin-Moore
prosthesis
Complications
non-union and avascular necrosis
Intertrochanteric
fractures
General considerations
Exuracapsular
fracture with better healing potential
Age:10 years older than femoral neck fracture
Classification(Boyd & Griffin)
Stable fractures
Type I: Nondisplaced fracture
Type II: Displaced fracture
Unstable fractures
Type III: Reverse,subtrochanteric,or
posteromedial comminution fracture
Type IV: Intertrochanteric fracture with
subtrochanteric fracture
Stability of fracture
Integrity of the posteromedial cortex is
the most important factor
Reverse fracture is more unstable
Subtrochanter fracture is more unstable
Treament
Stable fractures:
Close reduction with DHS(Dynamic hip
screw)
Unstable fractures:
Close reduction Gamma-nail(Small lever
arm)
Complications
Less non-union or avascular necrosis
Malunion happened in unstable
fractures
Thank you ( 3q )