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16 Cards in this Set
- Front
- Back
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Describe where hip fractures occur? Describe the three types of hip fracture? |
- theproximal (upper) portion of the femur, just outside the area wherethe femoral head (ball) meets the acetabulum (socket) - femoralneck fracture: between the femoral head and trochanters - intertrochanteric fractures: between the greater and lesser trochanteres - subtrochanteric fractures: distal to the trochanteres |
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Draw a diagram illustrating the location of femoral neck, subtrochanteric and intertrochanteric fractures |
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Discuss potential complication of femoral neck, intertrochanteric and subtrochanteric fractures |
femoral neck: bloodsupply to the femoral head is dependent on arteries that pass through the femoral neck. Can disrupt blood supply resulting in healingcomplications such as fracture nonunion (failed healing) or osteonecrosis. Intertrochanteric: good blood supply but c omplicatedby the pull of the hip muscles on the bony muscle attachments, whichcan exert competing forces against fractured bone segments and pullthem out of alignment.Can result in shorteningof the length of the femur or healing of the fracture in a misalignedposition (malunion). Subtrochanteric: bloodsupply is not as good as for intertrochanteric fractures and thusheals more slowly. Subtrochanteric fractures are also subject tocompeting forces exerted by muscular attachments on the femur thattend to pull the fractured fragments out of alignmen. |
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What is the short term goal of surgical treatment for a hip fracture? (4) |
stabilizethe hip fracture enough to withstand early mobilization and weightbearing to prevent complications from prolonged lack of motility |
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What is internal fixation? What types are there? |
metal implants placed in or anchored directlyalongside of bone to hold the fractured bony segments in alignmentuntil the fracture can fully heal |
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What is a non-displaced fracture? What is the most likely surgical intervention? |
fractures innormal or near-normal alignment generallyinvolves internal fixation: multiple stabilizing screws are placedfrom the outside (lateral) portion of the proximal femur through thefractured femoral neck, and anchored into the bone of the femoralhead. |
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What is a displaced fracture? What is the most likely surgical intervention? |
fractures moderatelyto severely misaligned Depends o patient and severity of the fracture. May be fixed with internal fixation or may need arthropasty (reconstruction/replacement of a joint. May be hemiarthroplasty of full. |
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Describe a hemiarthroplasty Describe a full arthroplasty |
replacementof the femoral head segment of the upper femur with an artificialimplant. The patient’s own acetabulum is not replaced Totalhip arthroplasty is the prosthetic replacement of the entire hipjoint, both the femoral head and the acetabulum within the pelvis. |
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Describe extramedullary and intramedullary internal fixation |
- extramedullary: plateis attached externally along the outside of the upper femur. Theplate is affixed along the outside of thefemur with multiple screws that cross the upper femur to hold it inplace. - intramedullary: pin/rod placedinside the canal of the femur, rather than alongside it, hence theterm intramedullary. |
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Describe the pathology of osteoarthritis |
-main changes are an increase/decrease in water content or articularcartilage, decrease in proteoglycan concentration (late) and a lossof collagen network - imbalance leaves the joint susceptible to damage -metalloproteinases are released from chondrocytes synovial cells which breaks down collagen -cartilage begins to soften (chondromalacia) and fibrillation occur on the surface -chondrocytes attempt to repair the cartilage, though its properties are more similar to fibrocartilage than hyaline cartilage (type I vs type II), and thus offers less protection - cartilage becomes increasingly eroded and bony spurs and cysts may appear at the margins to reduce friction - when the subchondral bone is exposed there is an increase in vascularisation and cellularity, followed by eburnation at areas of pressure - the breakdown and erosion of this cartilage signifies end-stagearthritis. |
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Describe the symptoms of OA (5) |
-gradual onset with increasing pain (deep) and disability -pain is often activity-related at the start, though in later stages there is pain even at rest -varying degrees of swelling, deformity and decrease in motion -stiffness in joints when waking (for no more than 15-30mins in morning) at after inactivity -crepitations (crackling) |
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What is the treatment plan for people with OA? |
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List 10 ways you can avoid slips, trips and falls? |
- immediately mopping up spillages - removing clutter, trailing wires and frayed carpet - using non-slip mats and rugs - using high-wattage light bulbs in lamps and torches, so you can see - clearly organising your home so that climbing, stretching and bending are kept to a minimum, and to avoid bumping into things - getting help to do things that you're unable to do safely on your own - not walking on slippery floors in socks or tights not wearing loose-fitting, trailing clothes that might trip you up - wearing well-fitting shoes that are in good condition and support the ankle - taking care of your feet by trimming your toenails regularly and seeing a GP or chiropodist about any foot problems |
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List 4 modifiable and non-modifiable risk factors of falling |
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What is hallux valgus? |
- a deformity of the big toe oftenreferred to as "a bunion" - medialdeviation of the first metatarsal and lateral deviation and/orrotation of the hallux, with or without medial soft-tissueenlargement of the first metatarsal head - Thetoe tilts over towards the smaller toes and a bony lump appears onthe inside of the foot. Sometimes a soft fluid swelling developsover the bony lump. |
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How is hallux valgus managed? (6) |
- Manypeople are comfortable if they wear wide, wellfitting shoes and give them time to adapt to the shape of their feet. - Spot-stretchingshoes or using shoes with wider and deeper toe boxes may beconsidered. - Asmall pad over the bony prominence, which can be bought from achemist or chiropodist, can take the pressure of the shoe off thebunion - Nonsteroidalanti-inflammatory drugs (NSAIDs) and physical therapy can be offeredto relieve acute, episodic inflammatory processes. - Corticosteroidinjections can also be useful for acute inflammatory conditions inthe first metatarsophalangeal (MTP) joint. - surgery can correct the deformity and give a more desirable shape, though there still may be some structural abnormality, and less than normal strength in the big toe |
