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fracture/dislocation of hip/pelvis - Coggle Diagram
fracture/dislocation of hip/pelvis
garden classification of femoral neck fractures:
-type 1: incomplete
-type 2: complete, nondisplaced
-type 3: complete, displaced <50% -type 4: complete, displaced > 50%
-pinning for types 1/2
-hemiarthroplasty for 3/4 due to disrupted blood supply
-<65 shoulder undergo ORIF
unipolar (femoral compt only) and bipolar (femroal and acetabular compt) arthroplasties
fracture prevention in elderly:
-weightbearing exercise, adequate calcium intake, decreasing caffeine, elimination of household hazards, treatment of impaired vision, hormonal implementation
Intertrochanteric fracture: evans classification
-type 1: fracture line extends superiorly and laterally
-type 2: fracture line extends inf and laterally
treatment: surgically with dynamic screw or intrameduallry device
detection of hip fractures
-bone scan: 80% detection rate within 24 hours, 100% SN at 3 days
-MRI 100% SN immediately for occult fractures
mortality rate for hip fractures
-10-30% in first year, then back to prefracture rate
morbidity: infection, ulcers, nonunion, fracture, dislocation, HO, DVT, PE, mechanical failure
greater/lesser tuberosity avulsions
-do well with bed rest and progressive weight bearing
-ORIF if widely displaced
subtrochanteric fracture: within 5cm distal to lesser trochanter
treatment for femoral shaft and ST fracture
-children: spica cast, traction, external fixation, or flexible nails
-older children/adults: intramedullary nail
rehab considerations after hip fracture
-capsular trauma is common, hip precautions should be
used in those with ORIF
-weightbearing should be used based on stability of fracture pattern and dislocation
men have greater risk of developing post surgical complications
-increased mortality/morbidity 1-2 years post fracture
-men more susceptible to infection/pneumonia
-men twice as likely to die within 2 years of hip fracture than women
patients who could not stand up, sit down, or walk within 2 weeks of hip surgery had highes mortality rates at 1 year follow up
morel-lavale lesion: closed degloving injury
-subcutaneous tissue is separated from fascia
-avascular tissue undergoes necrosis
-injury is caused by sig blunt trauma that results in acetabular fracture
-sig risk for infections
stable vs unstable pelvis fx:
-many classification systems
-single fractures does not typically lead to instability
-double breaks may lead to instability
-post sacroiliac lig most important structure for stability
-fractures that lie entirely outside ring are stable
malgaigne fracture: double vertical fx of pelvis
-typically sup/inf pubic rami fx assocated with ipsi sacral dislocation
-unstable
-possible leg length discrepancy
typical MOI for pelvic fx:
-low-velocity injuries in osteoporotic bone, often result from lateral compression of pelvis secondary to fall, typcially sup/inf pubic ramus
-high velocity trauma result from lateral compression, AP compression, or shear. more likely to be unstable
acetabular fx
-MOI: direct force transmitted from prox femur
-hip flexed, post wall fails
-hip extended, ant wall fails
long term complications from unstable pelvic ring: chronic low back pain, SI pain, residual gait abnormalities, leg length discrepancy
-<30% of patients with >1cm displacement are pain free at 5 years
hip dislocation
-90% posterior secondary to mechanism and weak post supporting capsule
-post: limb is flexed, adducted/IR
-ant: limb is shortened, abd, ER
-closed reduction
-neurovascular assessment continues for 24 hours
-gentle traction 24-48 hrs
complications: osteonecrosis, DJD, sciatic nerve injury, femoral head fracture