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MOD 7: Lecture 4
Problem B: hip and pelvic fractures
| Question | Answer |
|---|---|
| With what population are hip fractures more common | ppl over 65, women, previous family hx, decr. bone density, low Ca++ intake, smoking or excessive alcohol use, mental impairments (dimentia, alzheimers), meds that may cause weakness, diziness |
| Approximately how many americans are hospitalized per year as a result of a hip fracture? | 320,000 |
| What are the signs and symptoms of a hip fracture? | Swelling, deformity, abnormal movement, localized tenderness at the joint, Severe pain in the hip or groin, Inability to put weight on injured leg, Stiffness, bruising and swelling around hip, Shorter leg on injured side (Leg IR, add, & flexed)may be ER |
| Why do ppl with hip fx present with a shorter leg on the involved side? | because leg is IR (or ER but IR is more common) ADD and flexed |
| What are some extra-articular ligaments that may be injured as a secondary result of a hip fracture. | Iliofemoral, Pubofemoral, Ischiofemoral |
| What are some intra-articular ligaments that may be injured as a secondary result of a hip fracture? | Ligamentum teres, Transverse |
| What are some bursae that may be injured as a secondary result of a hip fracture? | Iliopsoas and Trochanteric bursae |
| What are some vascular structures that may be injured as a secondary result of a hip fracture? | Femoral artery, femoral vein |
| What are some muscles that may be injured as a secondary result of a hip fracture? | Gluteus medius, Iliopsoas, Hip adductors, Hamstring, Gluteus Maximus, Piriformis |
| What are some nerves that may be injured as a secondary result of a hip fracture? | Femoral – supplying the quads, Sciatic – supplying the HS, Obturator – supplying the adductor ms |
| What is the mechanism at the hip where there is an interconnection b/n the spine and pelvis. Hip jt functions in concert w/the pelvic girdle and the Lumbar spine | Lumbopelvic rhythm |
| With open chained activities, what motions accompany hip flexion? | posterior rotation of the innominate & flexion of the L/s |
| With open chained activities, what motions accompany hip extension? | ant rotation of the innominate & extension of the L/s |
| With closed chain activities, what motions of the hip and L/S mimic anterior pelvic tilt? | hip flexion and L/s extension |
| What are the symptoms of a distal femur fracture. | Knee joint is swollen (Can be mis-interpreted as ACL tear), Patella may be Fx |
| What is the Rx for distal femoral fracture? | Continuous skeletal traction, Internal fixation |
| What are some complications that may result following a distal femoral fracture? | Knee joint stiffness (person might be immobilized in ext) could turn into contracture, post-traumatic DJD |
| With closed chain activities, what motions of the hip and L/S mimic posterior pelvic tilt? | and hip extension and L/s flexion |
| What are the precautions patients should follow after a hip dislocations? | same precautions as THR; rotating the trunk to the right places the right hip in IR, and rotating the trunk to the L places the R hip in ER |
| What are the risk factors of hip fracture? | Age, Chronic medical conditions: OP, Gender, Heredity, Nutrition, Tobacco and alcohol use, Medications: prednisone, Environmental hazards: poor lighting, slipping in bath tub, throw rugs, using stepping stools |
| Name some types of femoral fractures. | Distal Femoral Fractures, Femoral Shaft, Intertrochanteric, Femoral Neck, Impacted Fx |
| Name 4 types of femoral neck fractures. | Intracapsular, Subcapital, Transcervical, Basilar |
| What are the symptoms of a femoral neck fracture? | Slightly shortened & ER leg, Hip motion is painful if they will even move |
| What is the Rx for a femoral neck fracture? | ORIF...if complications like AVN, Follow up Rx would be total joint replacement |
| What are the complications that may result from a femoral neck fracture? | AVN, non-union |
| According to Garden's classification of a femoral neck fracture, what is a type 1 fracture? | incomplete |
| According to Garden's classification of a femoral neck fracture, what is a type 2 fracture? | complete, but undisplaced |
| According to Garden's classification of a femoral neck fracture, what is a type 3 fracture? | partially displaced |
| According to Garden's classification of a femoral neck fracture, what is a type 4 fracture? | completely displaced |
| which 2 Garden's classifications of femoral neck fractures are more severe and put pts at an increased risk for AVN? | type 3 and 4 |
| What type of fx at the hip is reasonably stable b/c it compresses rather than displacing | impacted fx |
| Did you know... | since an impacted fx is more stable,functionally, pts may be walking |
| What are the signs and symptoms of an impacted fx? | No readily observable, not many signs externallyHAHA TRICK ? |
| How do you Dx an impacted fracture? | X-ray: need many views, Fracture in 2 places, Distal fragment nearly always being in abduction |
| What is the Rx for an impacted fx? | heals w/out surgery in ~ 3 months…a complication is that it may eventually become unstable |
| What is another name for an impacted fx? | compressed |
| What is the Rx for a disimpacted fx? | internal fixation is needed to stabilize |
| What is one difference between an impacted fx and a disimpacted fx? | impacted is more stable while a disimpacted is more unstable |
| The hip will dislocate under what amount of force. | A LOT! the hip joint has a lot of stability |
| Following a traumatic dislocation, what happens to the acetabulum? | if hip dislocates, force will traumatize acetabulum & it might fx |
| Signs and symptoms of a hip dislocation invlude | Swelling, Deformity, Abnormal mvt, Localized tenderness at the joint, Pain |
| Do posterior hip dislocations occur with a fracture? | they may or may not |
| Do anterior hip dislocations occur with a fracture? | they may or may not |
| Do central hip dislocations occur with a fracture? | yes, always |
| In what position is the hip joint most vulnerable? | flexion and ADD |
| What type of hip dislocation is the most common | posterior |
| What is the common mechanism of injury for posterior hip dislocations? | Position – flexion & adduction, force along the shaft of the femur (dashboard of car) |
| You suspect a posterior hip dislocation. What position is the leg in? | Shortening of the invloved leg, IR, add |
| What is a common injury that is associated with a posterior hip dislocation? | Fx of acetabulum or femoral head |
| What is the treatment for posterior hip dislocations? | CR (reduction needs to be done asap b/c of complications), hip-spica cast into extension, ABD and ER for 8 wks |
| Name some conditions you may see as a complication of a posterior hip dislocation. | AVN, sciatic n. lesion, DJD of the hip |
| What is the mechanism of injury behind an anterior hip dislocation? | Hip is extended, Forced abduction & ER of the leg |
| You suspect an anterior hip dislocation, what position would you expect to see the dislocated LE in? | flexion, ABD, & ER |
| Where would you palpate the femoral head if pt has an anterior hip dislocation? | ant below the inguinal crease |
| What is the Rx for an anterior hip dislocation? | CR, hip-spica cast into flexion, ADD and IR for 3 wks, Shorter time in immobilization b/c takes less force to ant dislocate then post |
| What is one complication that may eventually result from any of the hip dislocations? | DJD of the hip |
| What is the mechanism of injury behind a central fracture dislocation? | Severe blow to the lateral aspect of the hip w/ the hip in abduction |
| What is the Rx for a central fx dislocation at the hip? | continuous traction or surgery (depends on how severe) |
| Name 4 examples of early complications (and 1 late) of a THR. | Dislocation, Limp, Thromboembolic event, Infection = earlylate complication is like the implant loosening |
| Name some pathologies associated with THR. | Osteotomy, Fusion for the young |
| What is the mechanism of injury behind a pelvis fx? | Violent injuries: MVA, falls from great heights, cave-ins, & crushes. |
| What is the Rx for a pelvic fracture? | Cancellous bone, good blood supply therefore shorter healing time, w/or w/out surgery |
| What are some complications resulting from a fracture of the pelvis? | Extensive internal hemorrhage, Shock, Bladder or urethra damage, Sacral plexus injuries |
| What is the Rx for a stable pelvic fracture? | Reduction not required, Illium Fx may require PWB |
| How do you treat an unstable pelvic fracture? | Reduction, External fixation, full hip spica cast |
| What are some complications of an unstable pelvic fracture | Internal hemmorhage, Shock, Bladder and urethra damage, Sacral plexus injuries |
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