HIP FRACTURES

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.comwww.healthyjointclub.comwww.bonesandjointsclinic.com

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

HIP FRACTURES

BALL-AND-SOCKET JOINT: Ball shaped femoral head and cup shaped acetabulumThe upper end of thigh bone is made up of femoral head, neck and trochanter

Hip fractures can occur at -Femoral head,

-neck

-trochanter

HIP FRACTURES: FEMORAL NECK FRACTURES

Fracture adjacent to the femoral head in the neck between the head and the greater trochanter

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

FEMORAL NECK FRACTURES: CAUSES

Young :

-High velocity road traffic accidents

-Fall from heights

FEMORAL NECK FRACTURES: COMPLAINTS

-Pain in the injured hip

-Inability to bear weight

- Inability to move the hip

-Bruising over hip and groin

FEMORAL NECK FRACTURES: MANAGEMENT

Fall/injury to hip

Emergency/Clinic

X –rays & Necessary tests

FEMORAL NECK FRACTURES: INVESTIGATIONS

X-RAYS CT/MRISCANS

FEMORAL NECK FRACTURES: MANAGEMENT

Diabetes/Hypertension

Cardiac /Neurologicalconditions

Kidney / liver problems

Physician / Diabetologist opinion

Cardiologist / neurologist opinion

Specialist opinion

FEMORAL NECK FRACTURES: MANAGEMENT

2D Echo

Blood tests

Chest X ray/ ECG

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 femurHemiarthroplasty/Total Hip replacement.

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

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

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

POST OPERATIVE FOLLOW UP AFTER 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

FIXING FRACTURE NECK OF FEMUR

Implant failure Nonunion

Avascular necrosis of head of femur

Infection

Complications

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

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.

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

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

Frequent deep breathing 1

Pull your toes towards you and point away.

2 Circle your feet in both directions3

Push knee down Tighten thigh musclesCount to 10 and relaxDo 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

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

Raise and support your operated leg on a stool

Do walk short distances initially

As you get stronger increase the distance of walking

HEMIARTHROPLASTY

HEMIARTHROPLASTY: COMPLICATIONS

InfectionDeep vein

thrombosis(DVT)

Neurovascular injuries Dislocation of prosthesis

complications

CONTACTDr.A.MOHAN KRISHNAM.S.Ortho., MCh Ortho(U.K).,Consultant Orthopaedic Surgeon,Apollo Hospitals,Hyderabad.Appointments: Secretary : 09247258989 09441184590 08332936085 www.drmohankrishna.comwww.healthyjointclub.comwww.bonesandjointsclinic.comEmail: bonesandjointsclinic@gmail.com