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INTERTROCHANTERIC HIP FRACTURES

REASON FOR VISIT:

• Trauma to the hip


• Fracture of hip
• Osteoporosis
• Osteomalacia
• Benign tumors of bone
• Malignant tumors of bone
• Metastatic tumors (multiple myeloma )
• A motor vehicle accident
• Fall

RISK ASSESSMENT

• Pulmonary insufficiency
• Cardiac insufficiency
• Mitral valve insufficiency
• Aortic valve insufficiency
• Cardiovascular insufficiency
• Hypertension
• Dehydration
• Malnutrition
• Diabetes
• Hypothyroidism
• Bleeding disorder
• Old age
• Allergies to medications
• Allergies to anesthesia

PREPARATION OF THE PATIENT:

• Blood tests
• Urine tests
• X-ray chest
• SMA-12 (sequential multiple analysis–12-channel biochemical
profile)
• ECG
• X-ray pelvis (anteroposterior (AP) view), traction
• X-ray involved hip (anteroposterior (AP) view)
• X-ray involved hip (true lateral view (cross-table technique))
• X-ray involved hip (frog lateral view)
• CAT scan
• Reconstituted CAT scan
• CT scan
• Blood thinning medication was stopped before procedure
• Aspirin was stopped before procedure
• Patient was on fasting for ____hrs before procedure
• Part was cleaned with antiseptic solution and prepared

ANESTHESIA:

• General anesthesia
• Spinal anesthesia

POSITION OF THE PATIENT:

Supine position

THE PROCEDURE

• The patient was given general anesthesia / spinal anesthesia.


• The patient and the affected extremity were positioned on the
table

CLOSED REDUCTION

• Patient was relaxed


• Limb traction was done in longitudinal direction
• The fracture was fully extended
• The top of the greater trochanter was at the center of the
femoral head; at this point, the normal neck shaft angle was
restored.
• The leg was internally rotated to align the neck with the shaft in
the lateral view and to ensure proper anteversion.
• Appropriate images were obtained with 1 or 2 fluoroscopic
imaging (C-arm) machines.

OPEN REDUCTION

• The lateral hip and femur were prepared and draped.


• A lateral incision was made in the skin directly over the greater
trochanter and continued down through the overlying fascia and
muscles to the femur.
• The lateral femur was exposed
• A guidewire was drilled from the lateral femur to the femoral
head
• The angle between the wire and the femoral shaft was equal the
angle of the proposed fixation device, usually an angle of 135°.
• The tip of the guidewire was lying in the center of the femoral
head and 1 cm from the subchondral line on both the AP and
lateral views of the fluoroscopic images
• The guidewire was placed appropriately;
• The drilled hole was enlarged with the cannulated drills supplied
with the fixation device over the already placed guidewire.
• The lag screw was inserted into the femoral head.
• The side plate and barrel were placed over the screw, and the
guidewire was removed.
• The side plate was then attached to the femoral shaft with the
appropriate screws.
• Fluoroscopic images were taken throughout the repair to ensure
the maintenance of the reduced fracture position and the proper
positioning of the fixation device.
• After the appropriate fixation device has been placed, the
muscles, fascia, and skin were sutured

AFTER PROCEDURE:

• Patient was shifted to the intensive care unit


• Blood pressure, temperature, pulse rate was monitored

DURATION

_____hrs

POSTOPERATIVE CARE

• Keep incision area clean &dry


• Take antibiotics as prescribed
• Take pain medication as prescribed
• Take anticoagulants as prescribed
• Use antiembolism stockings
• Do periodic elevation of legs
• Protected weight bearing on crutches /walker

COMPLICATIONS

• Mal union
• Delayed union
• Non union
• Deformity
• Decreased function
• Infection
• Deep vein thrombosis
• Device failure
• Nerve injury