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Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Dec 21, 2015

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Page 1: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Hip

Page 2: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Fractures

Pelvic fx 20 MVA - 15,300/yr in U.S.

Proximal hip fx - 250,000/yr in U.S.

4.5/100 in people > 70 y.o.

Page 3: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Mechanisms

Femoral neck fxTrauma 20 falls

Lateral Rotation of LE w/ fall backwards

Stress fx

Page 4: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Mechanisms

Impact 20 fall subsequent fx

Fracture precipitates fall

Hip fx occur in < 5% of falls

Inverse relationship between hip fx and BMI

Page 5: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Mechanisms

Page 6: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Mechanisms

Page 7: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Mechanisms

Page 8: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Understanding the Mechanisms

Bone qualityMuscular strengthSoft tissue characteristicsNeuromuscular coordinationRare

Page 9: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Lever-Arm Dysfunction

Bony lever arms are abnormal due to abnormal bone development

Cerebral Palsy

Page 10: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Lever-Arm Dysfunction

Normal bone growth dependent on:GeneticsAdequate nutritionAdequate dynamic forces Bone deforms according to the:Forces placed on itLack of forces placed on it

Page 11: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Angle of Inclination

Infancy – 1500

Adult - 1250

Page 12: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Coxa ValgaG. Medius

G. MediusG. Medius

Page 13: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Femoral Torsion

• Approximately 400 - 450 (anteverted) in newborn

•150 in the adult

Page 14: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Femoral Torsion

Anteversion

Retroversion

Page 15: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Femoral Anteversion

Why in CP?Delayed standingAbnormal external forces 20 tone ligamentous laxity45 - 650

Page 16: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Femoral Anteversion

Manifestations:Hip abductor weakness resulting

from moment arm out of planeAnterior pelvic tilt maintain

femoral head coverage knee extension moment Hip IR,

Knee flexion and valgus

Page 17: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Femoral Anteversion

Manifestations:Internal foot progression angle

rockersAbnormal patellafemoral mechanics

Page 18: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Dislocation

High forcesUsually associate with acetabular

and/or femoral fxDirect - trochanterIndirect - foot or flexed knee

(“dashboard dislocation”)

Page 19: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Dislocation

Anterior (10-20% of hip dislocations)Forcible abduction

Abduction w/ flexion & ERobturator-type anterior dislocationAbduction w/ extensionpubic- or iliac-type dislocation

Page 20: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Dislocation

Retroversion risk of dislocation

Congenital hip dislocation (hip dysplasia)

Page 21: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Osteoarthritis/DJD

Most common joint disorder20 inflammationsoftening of cartilage 20

proteoglycanthinning pitting, fissuring, ulcerationsubchondral bone necrosisosteophyte formation

Page 22: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Osteoarthritis/DJD

Gradedjoint space

narrowingosteophyte

formationsclerosisjoint deformity

Page 23: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Osteoarthritis/DJD

Strongly associated w/…OnsetMTPwrist and spinetoe IPs and 1st carpometacarpaltibiofemoralhip

Page 24: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Osteoarthritis/DJD

Development:predispositionjoint abnormalitymechanical loadinguse

Page 25: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Osteoarthritis/DJD

Primary - idiopathicSecondarytraumametabolic disorders

CPDD DISH

Page 26: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Osteoarthritis/DJD

BiomechanicalBiochemicalInflammatoryImmunological

Page 27: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Osteoarthritis/DJD

Biomechanicaltraumaoveruse - occupationobesity

Page 28: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Muscle Strain

Occurs duringforced lengthening/eccentric

- control- decelerate high velocity

movementscompromised muscle ability to

absorb energy

Page 29: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Muscle Strain

Muscle compromise:fatiguepredisposing factors

- muscle imbalance- inflexibility- insufficient warm-up

Page 30: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Hamstring Strain

Susceptibletwo-joint musclessprinters

- late swing- early stance- high proportion of FT

Page 31: Hip. Fractures zPelvic fx 2 0 MVA - 15,300/yr in U.S. zProximal hip fx - 250,000/yr in U.S. z4.5/100 in people > 70 y.o.

Hamstring Strain

Most commonproximalbiceps femoris long headmyotendinous junction

- actual interface (folding) more shearing than tensile - limited extensibility