My Orthopedic Surgery

From Journal RCSE

December 3, 2007 — An algorithm composed of 11 readily available clinical variables offers a simple means to stratify the 5-year risk of hip fracture in postmenopausal women, according to the results of a study published in the November 28 issue of the Journal of the American Medical Association.
There were 11 factors associated with the increased risk for hip fracture within 5 years: age, self-reported health, weight, height, race or ethnicity, self-reported physical activity, history of fracture after age 54 years, parental hip fracture, current smoking, current use of corticosteroids, and treated diabetes.

AO Classification of Hip Fractures

BMJ 1997;315:221-225 (26 July) Chris E D H De Laet, Ben A van Hout, Huibert Burger, Albert Hofman, Huibert A P Pols
Conclusions: The risk of hip fracture by age and bone density is similar in men and women. The decrease in bone density associated with age makes a limited contribution to the exponential increase of the risk of hip fracture with age.

Abstract from Archives Internal Medicine April 2005

Update in eMJA of 1996 study "How best to fix broken hips" (qv) Michael N Chilov, Ian D Cameron and Lyn M March MJA 2003; 179 (9): 489-493

broad range of forces acts upon the hip joint;
- muscles that cross hip joint generate most of the load that it bears;
Wheeless' Textbook of Orthopaedics

Prophylaxis using heparin and low molecular weight heparin
Heparins and some mechanical pumping devices may help prevent blood clots forming in the legs after surgery for hip fracture
Patients with hip fracture may develop blood clots (thrombosis) in their legs. Some of these blood clots may travel to the lungs and cause a blockage (embolism), which can be fatal. Various drugs and physical devices are sometimes used to try and prevent these complications. This review of randomised trials found that both heparins and mechanical pumping devices significantly decrease the incidence of deep vein thrombosis. There was not enough evidence to conclude about the effect on lung (pulmonary) embolism, mortality or possible side effects for either heparin or mechanical methods.
Handoll HHG, Farrar MJ, McBirnie J, Tytherleigh-Strong G, Milne AA, Gillespie WJ

Hip fractures are classified as intracapsular, which includes femoral head and neck fractures, or extracapsular, which includes trochanteric, intertrochanteric, and subtrochanteric fractures. The location of the fracture and the amount of angulation and comminution play integral roles in the overall morbidity of the patient, as does the preexisting physical condition of the individual. Fractures of the proximal femur are extremely rare in young athletes and are usually caused by high-energy motor vehicle accidents or significant trauma during athletic activity. Other causes may be an underlying disease process such as Gaucher disease, fibrous dysplasia, or bone cyst. Identification and initiation of treatment is imperative in attempts to avoid complications, such as avascular necrosis (AVN). AVN is more common in patients in the pediatric and adolescent age groups. This outcome is due to the precarious nature of the blood supply to the subchondral region of the femoral head, which does not stabilize until years after skeletal maturity, after which collateral flow develops.
Synonyms and related keywords: femoral neck fracture, intracapsular hip fracture, hip stress fracture, femoral neck stress fracture, femoral stress fracture, Garden classification, Colonna classification, Evan classification, broken hip, fractured hip, cracked hip
Bhatti & Ertl 2005

Full text version of article in eMJA

A 10 Year Longitudinal Study AAOS Meeting Abstract 2005

October 9, 2007 — One-year mortality after a second hip fracture (24.1%) was higher than 1-year mortality after a first hip fracture (15.9%), and the first hip fracture was an indicator for likelihood of a second hip fracture, according to results from the Framingham Heart Study reported in the October 8 issue of the Archives of Internal Medicine.

Hip fracture is a common serious injury that occurs mainly in older people. For many previously fit patients it means loss of prior full mobility; for some frailer patients the permanent loss of the ability to live at home. And for the frailest of all it may bring pain, confusion and disruption to complicate an already distressing last illness. Mortality after hip fracture is high: around 30% at one year. Despite significant improvements in both surgery and rehabilitation in recent decades, hip fracture remains, for patients and their carers, a much-feared injury.

Hip padding systems

Online Reference of surgical technique