Complications In Hip Fractures - Everything You Need To Know - Dr. Nabil Ebraheim
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- เผยแพร่เมื่อ 3 พ.ค. 2017
- Dr. Ebraheim’s educational animated video describes complications associated with hip fractures.
Dislocations: Dislocations occur more in total hip arthroplasty than hemiarthroplasty. Avoid activity that causes dislocation after a total hip surgery! Total hip arthroplasty is done in physiologically active elderly patients with a displaced femoral neck fracture. Although it may increase the risk of dislocation, there is a lower revision rate and a superior long term future outcome.
Failure of Fixation: Quality and maintenance of reduction of the fracture is important. Closed reduction can be attempted, however the reduction must be anatomic. If it is not anatomic reduction, then an open reduction should be done. Open reduction can be done through an anterior approach or a Watson-Jones approach. When the fixation fails, you can attempt to repeat ORIF or you may do prosthetic replacement. It should be noted that in the elderly patient, treatment of displaced femoral neck fractures with screws may have failures and revision rates up to 40%.
Fracture Distal to the Fixation: Probably due to screw placement at or below the lesser trochanter and poor bone quality, especially if you start anteriorly and not laterally. Also may be due to poor angle of the screw fixation and multiple attempts at drilling or guide pins. Treatment will include refixation of the femoral neck and the subtrochanteric fracture.
Nonunion of the Fracture: Femoral neck fractures are considered to be intracapsular fractures which are at a high risk of developing nonunion. It can present itself by groin or buttock pain, pain with hip extension, or with weight bearing. It can occur in about 5% of nondisplaced fractures and in about 25% of displaced fractures. If it occurs in the elderly patient, do arthroplasty. If it occurs in the young patient, do valgus intertrochanteric osteotomy. Vascularized fibular graft may benefit the patient. Nonunion occurs more in the vertically oriented fracture pattern with loss of reduction and varus collapse. In the younger patient, we may possibly reorient the fracture line to be more horizontal by doing the osteotomy.
Medical: There is an increased risk of DVT up to 80%. Some form of prophylaxis is indicated, both mechanical and pharmacological for the patient. Consult the medial team for co-management. The aim of treatment is early embolization of the patient with pulmonary toilet. There is a high mortality rate in the elderly (approximately 30% in one year). Surgical delay more than 72 hours will increase the risk of one year mortality.
Osteonecrosis (AVN): The patient will have groin, buttock or proximal thigh pain. It occurs in 10% of nondisplaced fractures and in 30% of displaced fractures. AVN could occur due to interruption of the terminal branch of the medial femoral circumflex artery by the fracture. AVN may occur due to an increase in the initial displacement, increase in the time to reduce or nonanatomic reduction. In younger patients with less than 50% femoral head involvement, treatment may include a valgus intertrochanteric osteotomy.
Penetration of the Screws into the Hip Joint: Put the screws within 5 mm of the articular cartilage. Use multiple fluoroscopy images to confirm that there is no penetration. The screws have to be parallel so that it allows compression of the fracture. Make sure that the threads of the screws cross the fracture site, otherwise the treads will distract the fracture. You may use long threads or short threads based on the situation.
Shortening: Femoral neck shortening after fracture fixation with multiple cancellous screws can be a problem. The healed femoral neck fracture with shortening is usually associated with a poor functional outcome.
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Very nice way to describe...
Any advice on exercising after this type of surgery
thank you ...
I had surgery on a fractured hip.
I was doing very well from it.
But suddenly after maybe to much activity.
I have gone back to the pain level I had after surgery. Way worse then when I came out of the hospital. I have the big Rod in my Femur then two smaller rods in the hip bone to stabilize the larger Rod.
I don't remember the technical term for it and nobody gave me any written information.
I am 61 years old and have had also both knees replaced and have severe osteoporosis.
Am I considered elderly?
Should I be concerned of this new problem?
I did contact the original surgeon for my hip, but that was very unhelpful from the secretary just telling me to wait it out for six months or a year. But being that I was so much better before a few weeks ago I'm concerned.
get another ortho doctor to x-ray your hip and evaluate the outcome. The original doctor may not want to reevaluate for fear of a lawsuit.
I fractured my hip years ago I still have pains and it locks up sometimes to the point it’s hard to walk I have a little limp is that normal
thanks very much
Hello sir..my father same intracapsular fracture but suger Blood pressure nothing control Pls help me sir
Hi thank you for the video, it would be awesome if you can make one about femur/tibia/fibula fracture orthopedic surgery with the rods and screws. I was in a motorcycle accident last year and fractured my right leg into 7 pieces. The screws they put through the hip into the femur has a little amount of pain and my knee where they put the intramedullary rod's cap on after it was inserted causes some pain as well. I would love to learn more about this.
Viewing hi
I hope u r doing.. please tell me about your recovery process. As i have also met with an accident.
@@vinayakshrivastav4090 please rply mujha b hip dislocate hua hai
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Pin ko nekalne me kitna time
Lagta h
How many months required to remove the screws
Don't need to remove them.but you can after it's fully healed, would recommend after at least 1 1/2 yr
Hello Doctor I have a grandfather who has a hip fracture doctors are saying that they are not sure to do a surgery because my grandfather is 77 years old, Doctors are saying that he can not handle the surgery, So Can you give any suggestion? Thank you very much beforehand.
راائــــــــــــع
:D
Sir i am 45 yesrs old i had leanear non displaced fracture, I have fixed through 3 screws, how much time it takes to heal please??
Hj