HIP FRACTURES Dr Deepa Abichandani Overview Incidence is

HIP FRACTURES Dr. Deepa Abichandani

Overview • Incidence is highest in >65 years of age but also in young adults due to RTA • F>M • Two types: intracapsular and extracapsular

Anatomy Of Hip Joint

$Blood Supply Of Femur • Intracapsular fractures are at risk of non union and$

Blood Supply Of Femur • Intracapsular fractures are at risk of non union and avascular necrosis due to interruption of the blood supply to the femoral head via cruicate (med and lat circumflex) and intramedullary vessels

$Classification Of Femur fracture I. Intracapsular: Subcaptial Transcervical Basicervical II. Extracapsular: Intertrochanteric subtrochanteric$

Classification Of Femur fracture I. Intracapsular: Subcaptial Transcervical Basicervical II. Extracapsular: Intertrochanteric subtrochanteric

$Garden Classification Garden I: incomplete fracture of the femoral neck Garden II: complete fracture$

Garden Classification Garden I: incomplete fracture of the femoral neck Garden II: complete fracture without displacement Garden III: complete fracture with partial displacement Garden IV: complete fracture with full displacement

Pauwels Classification

Intertrochanteric Fracture • Common MOI result of fall (direct / indirect) • Occurs along the line of greater and lesser trochanter. • An extracapsular fracture. • Classified by Evans as stable or unstable • Most commonly used classification is Jensen where type 1&2 are stable and 3 -5 are unstable

Intertrochanteric Fracture

Intertrochanteric Fracture (Jensen. Classification )

Sub-trochanteric Fractures • Common MOI trauma to the area between the lesser trochanter and 5 cm distal to it. • Commonly used classification Seinsheimer classification.

Sub-trochanteric Fractures (Seinsheimer classification)

Intracapsular Fractures • Subcapital Fracture • Transcervical Fracture • Basicervical Fracture

Subcapital Fracture

Transcervical Fracture

Basicervical Fracture

Post-Operative Rehabilitation Maximum Protection Phase : § Prevent vascular & pulmonary complications § Improve strength of upper limbs & unaffected lower limb. § prevent post-operative reflex inhibition of hip & knee musculature. § Restore active mobility & dynamic control of the affected hip & adjacent joints.

Post-Operative Rehabilitation Moderate & Minimum Protection Phase : § Increase flexibility of any chronically shortened muscles. § Improve strength & muscular endurance in the lower extremities for functional activities. § Improve postural stability and standing balance. § Increase aerobic capacity