Femoral Neck Fractures

What does a posterolateral approach allow to remain intact

- allows for abductor muscles to remain intact * however, may be a higher incidence of post-op joint instability due to interruption of posterior capsule

What are the surgical precautions for a posterolateral approach

- avoid internal rotation - avoid excessive hip flexion past 90 - avoid adduction

describe the labrum of the hip and explain its function

- the labrum is made of fibrous cartilage which is similar to the meniscus in the knee, and it runs around the bony rim of the acetabulum. -The labrum functions to deepen the socket adding stability to the hip joint as well as cushioning the joint itself

What is the treatment for femoral shaft fractures

-skin traction: conservative management is carried out using skin traction and prolonged bed rest. The problem with this is long bed rest leads to muscle atrophy and the patient won't be able to weight bear -Internal fixation (method of choice): a long intramedullary nail is inserted in the medullary cavity of the femur from the greater trochanter to the knee. Held by proximal and distal locking screws. ** Good because patient can weight bear quickly which will stimulate bone growth**

What are some reasons for non-compliance after a hip replacement (4)?

1. Fear 2. Pain 3. swell - leg is heavy and painful 4. Reflex inhibition-patients resist movement of the joints above or below, especially painful quad stretch

What are 3 common reasons for hip replacement surgery?

1. OA - the most common cause 2. AVN 3. abnormalities of hip joint function: resulting from fractures of the hip and some types of hip conditions that appear in childhood other causes include - failed internal fixation of a fracture - RA - osteomyelitis - bone infection

What are 4 potential problems with femoral shaft fractures

1. blood loss- there may be a large degree of blood loss into the surrounding tissue. With mid-shaft fractures there may be as much as 1/2-1 liter of blood lost into the thigh musculature 2. shock-this volume of fluid loss may cause the patient to go into shock 3. trouble weight-bearing: usually impossible with associated shortening of the affected limb 4. fat embolism: potentially fatal

What are 3 types of femoral acetabular impingements that can cause labral tears?

1. cam deformity: excess of bone along the upper surface of femoral head 2. pincer deformity: excess of bone growth on upper lip of acetabular cup 3. combination of cam/pincer deformity

List 3 tests that will be positive with a hip labral tear?

1. impingement test: flexion-adduction-interal rotation 2. axial compression test: flexion- adduction 3. McCarthy test: For the McCarthy test, both hips have to be in a flexed position. The affected hip needs to be brought into extension. If this movement reproduces a painful click, the patient is suffering from a labral tear.

List 4 locations where femoral neck fractures can occur?

1. intertrochanteric - between the greater and lesser trochanter 2. trascervical neck fracture 3. subtrochanteric - below the trochanters 4. subcaptial- at junction the femoral head and neck

what are 5 common symptoms of a labral tear?

1. pain- usually located on the inner hip or groin area 2. a "catching" sensation within the joint, with twisting motion under load 3. chronic pain with gradual loss of function 4. instability/giving way 5. complaints of clicking/locking with pain

What are 2 contraindications to hip replacement surgery

1. poor periarticular support 2. sepsis - active infection

What are 4 complications to hip replacement surgery

1. thrombophlebitis 2. infection 3. dislocation 4. loosening of the joint

how long can you expect an artificial hip to last?

12-15 years

Traumatic hip dislocation requires immediate treatment, ideally within what time frame?

6 or less hours

What is the usual treatment of femoral neck fracture

ORIF - open reduction internal fixation This occurs if blood supply has not been affected

Subcapital fractures may be best treated with what type of surgery? What condition may develop after a subcaptial fracture occurs

Prosthetic replacement of femoral head, and the patient runs the risk of developing AVN

When a hip dislocates more than once what needs to be done by the surgeon?

another operation to make the joint more stable

After a femoral neck fracture, what is the typical presentation of the affected side?

apparent shortening of the leg on the affected side with the involved leg falling into external rotation

What are the hip precautions for an anterolateral hip replacement approach

avoid excessive hip extension, adduction and external rotation

Why is a hip dislocation and emergency?

because unless the dislocated hips is reduced (replaced in its socket) promptly, and normal circulation is returned, there can be permanent damage to the head of the femur. This permanent damage is called AVN

Femoral neck fractures are usually displaced, how are they broken?

comminuted - broken into fragments

What causes labral tears?

degenerative changes or a traumatic event

Are femoral neck fractures more common in males or females? why?

females due to an increased incidence of osteoporosis after menopause. Injury results from trauma, usually a fall

What is the major reason artificial joints fail?

loosening of the joint where the metal or cement meets the bone

What artery is always compromised in femoral neck fractures

medial femoral circumflex artery

What is thrombophlebitis

occurs when the blood in the large veins of the leg forms a blood clot. Dangerous because clots can break free and travel to the lungs

what is the most common surgical approach for a total hip replacement

posterolateral