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Outline:
1. Facts & Figures
2. Classification of the hip fractures
3. Surgery
4. Complications
5. Mobilisation after hip fracture
Mortality rates:
• Mortality rates can be up to 30% at 1 year.
• Mortality rates are higher in men than women.
• Mortality is usually due to: Infection e.g. pneumonia, septicaemia,
influenza, Myocardial infarction, CVA, Cardiac decompensation
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Band 5 Presentation Fractured Neck of Femur Rónán Donohoe, 11 May ‘10
Garden’s Classification
I - Incomplete or Impacted
II - Complete no displacement
III - Complete with partial displacement
IV- Complete with total displacement
3. Surgery
The primary concern with femoral neck
fractures is that the damaged blood supply to
the bone will lead to avascular necrosis (AVN) of the femoral head.
In these cases, patients may require a THR.
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Band 5 Presentation Fractured Neck of Femur Rónán Donohoe, 11 May ‘10
Arthroplasty / Prostheses
Usually for # NOF in Elderly > 60 years
Involves prosthetic replacement of one or both sides of a joint
• Hemiarthroplasty
1. Unipolar prosthesis (where only the head is replaced)
• Austin Moore prosthesis (cementless)
• Thompson prosthesis (cemented)
Note: titanium implants are capable of osteointegrating without cement
4. Complicaitons
Main Risks Following ORIF:
• Non–Union 20-30%
• Avascular Necrosis 10-20%
• Conversion needed 25-30%
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Band 5 Presentation Fractured Neck of Femur Rónán Donohoe, 11 May ‘10
Postoperative (day 1)
• Initiation of bedside exercises - Such as ankle pumps, quadriceps sets, and
gluteal sets
• Review of hip precautions and weight-bearing status
• Initiation of bed mobility and transfer training - Bed to/from chair
Postoperative (day 2)
• Initiation of gait training with the use of assistive devices, such as crutches
and a walker
• Continuation of functional transfer training
Postoperative (days 3-5 or on discharge to the rehabilitation unit)
• Progression of ROM and strengthening exercises to the patient's tolerance
• Progression of ambulation on level surfaces and stairs (if applicable) with the
least restrictive device14
• Progression of ADL training
Postoperative (day 5 to 4 weeks)
• Strengthening exercises - For example, seated leg extensions, side-
lying/standing hip abduction, standing hip extension and hip abduction, knee
bends, bridging
“There is insufficient evidence from randomised trials to establish the effectiveness of the
various mobilisation strategies used in rehabilitation after hip fracture surgery. Further
research is required to establish the possible benefits of the additional provision of
interventions, including intensive supervised exercises, primarily aimed at enhancing
mobility.”
References:
• Lawrence TM, White CT, Wenn R, Moran CG. The current hospital costs of
treating hip fractures. Injury. 2005; 36(1):88-91.
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Band 5 Presentation Fractured Neck of Femur Rónán Donohoe, 11 May ‘10
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