Page 964 - TNFlipTest

OR30 Orthopedics
Hip
Toronto Notes 2019
Table 21. Garden Classification of Femoral Neck Fractures
Type Displacement
I None
II None
III Some
IV Complete
Extent
“Incomplete”
Complete Complete
Complete
Alignment
Valgus or neutral
Neutral Varus
Varus
Trabeculae
Malaligned
Aligned Malaligned
Aligned
Treatment
Internal fixation to prevent displacement (valgus impacted fracture)
Internal fixation to prevent displacement
Young: ORIF
Elderly: hemi-/total hip arthroplasty
Young: ORIF
Elderly: hemi-/total hip arthroplasty
Type III Type IV
TypeI
Figure 36. Garden classification of femoral neck fractures
Arthritis of the Hip
Etiology
Type II
• OA,inflammatoryarthritis,post-traumaticarthritis,lateeffectsofcongenitalhipdisorders,orseptic arthritis
Clinical Features
• pain(groin,medialthigh)andstiffnessaggravatedbyactivity,betterwithrestinOA • RA:morningstiffness>1h,multiplejointswelling,handnodules
• decreasedROM(internalrotationislostfirst)
• crepitus
• effusion
• ±fixedflexioncontractureleadingtoapparentlimbshortening(Thomastest) • ±Trendelenburgsign
Investigations
• X-ray:weight-bearingviewsofaffectedjoint
■ OA: joint space narrowing, subchondral sclerosis, subchondral cysts, osteophytes ■ RA: osteopenia, erosion, joint space narrowing, subchondral cysts
• bloodwork:ANA,RF
Treatment
• non-operative
■ weight reduction, activity modification, physiotherapy, analgesics, walking aids
• operative
■ indication: advanced disease
■ realign = osteotomy; replace = arthroplasty; fuse = arthrodesis
• complicationswitharthroplasty:componentloosening,dislocation,HO,thromboembolism,infection, neurovascular injury, limb length discrepancy
• arthroplastyisstandardofcareinmostpatientswithhiparthritis
Hip Dislocation Post-Total Hip Arthroplasty
• occursin1-4%ofprimaryTHAand10-16%ofrevisionTHAs
• riskfactors:neurologicalimpairment,post-traumaticarthritis,revisionsurgery,substanceabuse
Mechanism
• THAthatisunstablewhenhipisflexed,adducted,andinternallyrotated,orextendedandexternally rotated (avoid flexing hip >90° or crossing legs for ~6 wk after surgery)
Investigations
• X-ray:APpelvis,APandlateralhip
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