Hips: Fractures, Investigations, Methods of Management in Different Age Groups

This is short presentation of most common fracture in hip joint. Femoral neck fractures are the most common type of fractures around the hip joint- more common in elderly in weak osteoporotic bone. This presentation gives a brief idea about these fractures, investigations, methods of management in different age groups.

Krishna Dr. A. Mohan Krishna, M.S. Ortho, MCh Orth(UK) is currently a consultant orthopedic surgeon at Apollo Hospitals, Jubilee Hills. He is part of the orthopedic team and he specializes in fracture management, arthroscopy, primary hip and knee arthroplasties, and paediatric orthopedics. He has presented papers in the orthopedic specialty.
Presentation used with permission from Dr. A. Mohan Krishna.

Presentation Transcript

  1. Dr. A.MOHAN KRISHNA M.S.ORTHO, MCh ORTH(U.K) Consultant Orthopaedic surgeon , Trauma, Arthroscopy, Arthroplasty Surgeon Apollo hospitals, Hyderabad Consultant Orthopedic Surgeon at www.drmohankrishna.com www.healthyjointclub.com www.bonesandjointsclinic.com
  2. This presentation is solely for educational purpose. The material included in the presentation represents educational material for the patients and not intended for any treatment purpose DISCLAIMER
  3. HIP FRACTURES BALL-AND-SOCKET JOINT: Ball shaped femoral head and cup shaped acetabulum The upper end of thigh bone is made up of femoral head, neck and trochanter Hip fractures can occur at -Femoral head, -neck -trochanter
  4. HIP FRACTURES: FEMORAL NECK FRACTURES Fracture adjacent to the femoral head in the neck between the head and the greater trochanter
  5. FEMORAL NECK FRACTURES: CAUSES Elderly : Common / weak osteoporotic bone Common cause in elderly : - Due to slip and fall on the hip - Direct blow on the hip - Trivial twisting injury to the leg
  6. FEMORAL NECK FRACTURES: CAUSES Young : -High velocity road traffic accidents -Fall from heights
  7. FEMORAL NECK FRACTURES: COMPLAINTS -Pain in the injured hip -Inability to bear weight - Inability to move the hip -Bruising over hip and groin
  8. FEMORAL NECK FRACTURES: MANAGEMENT Fall/injury to hip Emergency/Clinic X –rays & Necessary tests
  10. FEMORAL NECK FRACTURES: MANAGEMENT Diabetes/Hypertension Cardiac /Neurological conditions Kidney / liver problems Physician / Diabetologist opinion Cardiologist / neurologist opinion Specialist opinion
  11. FEMORAL NECK FRACTURES: MANAGEMENT 2D Echo Blood tests Chest X ray/ ECG
  12. FEMORAL NECK FRACTURES: MANAGEMENT Head of Femur : Precarious blood supply – Injury or fracture damages blood supply Avascular necrosis subsequent arthritis Young individuals Up to age of 50 years Preserve Head by fixing the fracture Elderly : above 50 years / weak osteoporotic bone Replace Head of femur Hemiarthroplasty/ Total Hip replacement.
  13. FEMORAL NECK FRACTURES: FIXING FRACTURE NECK OF FEMUR SCREW FIXATION: - Under Spinal anaesthesia - Fracture is reduced - Fixed with 2 or 3 screws - Special X ray machine – C-Arm is used - Done through small incision on upper part of thigh
  14. FIXING FRACTURE NECK OF FEMUR DYNAMIC HIP SCREW FIXATION (DHS) - Under Spinal anaesthesia - Fracture is reduced - Fixed with large screw and side plate assembly - Special X ray machine – C-Arm is used - Done through small incision on upper part of thigh
  15. FIXING FRACTURE NECK OF FEMUR DAY 1 in the hospital • Moving in and out of bed • Walking with the help of walker without weight on operated leg Day 2 • Plan for discharge • Basic exercises in bed Discharge advice • Revisit after 2 weeks for stitch removal • Not to sit on the ground or cross legged
  16. POST OPERATIVE FOLLOW UPAFTER FIXING HIP FRACTURES 6 weeks follow up • X-ray to see progress of healing • Partial weight bearing with walker 3 months after surgery • X ray to see the progress of healing • Full weight bearing on the operated leg 3 months to 6 months after surgery • Fracture healing takes 3 to 6months • Follow up every 6 weeks till fracture heals
  17. FIXING FRACTURE NECK OF FEMUR Implant failure Nonunion Avascular necrosis of head of femur Infection Complications
  18. FEMORAL NECK FRACTURES: HEMIARTHROPLASTY Elderly : above 50 years / weak osteoporotic bone Replace Head of femur - Hemiarthroplasty - Total Hip replacement. HEMIARTHROPLASTY: Surgery in which ball of the hip joint replaced by metallic ball
  19. HEMIARTHROPLASTY: Surgery HEMIARTHROPLASTY: -Spinal anaesthesia. - Hip joint is opened and ball is removed. - Thigh bone is prepared to hold the prosthesis with or without the help of cement. - Artificial ball is relocated into the acetabulum of hip joint.
  20. Day 1 Exercises for ankles and toes to prevent blood clots. Full weight bearing walking with walker. You can sit on a chair or take a few steps with a frame Day 2 Removal of bandage and drain from the Hip joint Knee exercises – straightening / bending. Allowed to go to bathroom. Day 3 Walking up and down the stairs Continue the exercises You may be able to go home within 3 to 4 days after the operation HEMIARTHROPLASTY: Postoperative advice
  21. Stitches / clips removed at 12 - 14 days You can shower/ bathe after removal of stitches / clips Return to household work & other day to day activities in 6-8 weeks HEMIARTHROPLASTY: Postoperative advice
  22. Frequent deep breathing1 Pull your toes towards you and point away. 2 Circle your feet in both directions 3 Push knee down Tighten thigh muscles Count to 10 and relax Do it 10 times / hour 4 Place a rolled towel under your knee. Lift your heel to straighten knee. Count to 10 and do 10 times / hour 5 Place a rolled towel under your knee. Push your knee and heel down. Count to 10 and do 10 times / hour 6 HEMIARTHROPLASTY: Exercises
  23. Sit at the edge of bed / chair. Bend the operated leg and straighten slowly. Repeat 10 times/hour. 7 Note: it is important to do frequent repetitions of all exercises for a short time than spending more time on exercises once or twice a day. Do not force any movements HEMIARTHROPLASTY: Exercises
  24. Raise and support your operated leg on a stool Do walk short distances initially As you get stronger increase the distance of walking HEMIARTHROPLASTY
  25. HEMIARTHROPLASTY: COMPLICATIONS Infection Deep vein thrombosis(DVT) Neurovascular injuries Dislocation of prosthesis complications
  26. CONTACT Dr.A.MOHAN KRISHNA M.S.Ortho., MCh Ortho(U.K)., Consultant Orthopaedic Surgeon, Apollo Hospitals, Hyderabad. Appointments: Secretary : 09247258989 09441184590 08332936085 www.drmohankrishna.com www.healthyjointclub.com www.bonesandjointsclinic.com Email: bonesandjointsclinic@gmail.com