35
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Hip Fractures: Relevant Anatomy, Classification, and Biomechanics of Fracture and Fixation

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introduction:

          Hip fractures represent an important health-care dilemma, costing the US$ billions annually. Hip fractures can diminish quality of life and significantly increase morbidity and mortality if not properly treated. Recent research has brought forth new information regarding treatment as well as information on emerging complications seen within the fixation constructs themselves.

          Significance:

          Understanding the pathoanatomy of hip fractures and the biomechanics of surgical fixation constructs is critical for successful treatment. In this article, we review the relevant anatomy and classification of femoral neck and intertrochanteric fractures. Furthermore, the biomechanics of hip fracture fixation strategies as well as implant-related complications are addressed.

          Results:

          Even though laboratory testing demonstrated that intramedullary nails have greater biomechanical stability, the clinical results between fixation constructs have been similar when the chosen implant (ie, sliding hip screw vs cephalomedullary nail) has been correctly applied to the specific fracture pattern. Recently, data have shown that when using cephalomedullary nails, there is potential for increased failure with cutout when using the helical blade versus the lag screw, with majority being the atypical “medial cutout.”

          Conclusion:

          The goal of surgical treatment of hip fractures is surgical treatment that allows for early mobilization and weight bearing. A full understanding of the anatomy and fracture characteristics will allow the surgeon to correctly apply the right implant to allow for uneventful healing. Surgeons need to be aware, however, of complications that can arise when using specific implants. Further research is ongoing to further determine the treatments that will allow optimal cost-effective care for the geriatric patient with hip fracture.

          Related collections

          Most cited references54

          • Record: found
          • Abstract: found
          • Article: not found

          Estimating hip fracture morbidity, mortality and costs.

          To estimate lifetime morbidity, mortality, and costs from hip fracture incorporating the effect of deficits in activities of daily living. Markov computer cohort simulation considering short- and long-term outcomes attributable to hip fractures. Data estimates were based on published literature, and costs were based primarily on Medicare reimbursement rates. Postacute hospital facility. Eighty-year-old community dwellers with hip fractures. Life expectancy, nursing facility days, and costs. Hip fracture reduced life expectancy by 1.8 years or 25% compared with an age- and sex-matched general population. About 17% of remaining life was spent in a nursing facility. The lifetime attributable cost of hip fracture was $81,300, of which nearly half (44%) related to nursing facility expenses. The development of deficits in ADLs after hip fracture resulted in substantial morbidity, mortality, and costs. Hip fractures result in significant mortality, morbidity, and costs. The estimated lifetime cost for all hip fractures in the United States in 1997 likely exceeded $20 billion. These results emphasize the importance of current and future interventions to decrease the incidence of hip fracture.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip.

            Failure of fixation of peritrochanteric fractures that have been treated with a fixed-angle sliding hip-screw device is frequently related to the position of the lag screw in the femoral head. A simple measurement has been developed to describe the position of the screw. This measurement, the tip-apex distance, is the sum of the distance from the tip of the lag screw to the apex of the femoral head on an anteroposterior radiograph and this distance on a lateral radiograph, after controlling for magnification. To determine the value of this measurement in the prediction of so-called cutout of the lag screw, 198 peritrochanteric fractures (193 patients) were studied. The minimum duration of follow-up was three months (average, thirteen months), during which period all of the fractures either healed or had failure of the fixation. Of the nineteen failures that were identified, sixteen were due to the device cutting out of the femoral head. The average tip-apex distance was twenty-four millimeters (range, nine to sixty-three millimeters) for the successfully treated fractures compared with thirty-eight millimeters (range, twenty-eight to forty-eight millimeters) for those in which the screw cut out (p = 0.0001). None of the 120 screws with a tip-apex distance of twenty-five millimeters or less cut out, but there was a very strong statistical relationship between an increasing tip-apex distance and the rate of cutout, regardless of all other variables related to the fracture.(ABSTRACT TRUNCATED AT 250 WORDS)
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Bone mechanical properties and changes with osteoporosis.

              This review will define the role of collagen and within-bone heterogeneity and elaborate the importance of trabecular and cortical architecture with regard to their effect on the mechanical strength of bone. For each of these factors, the changes seen with osteoporosis and ageing will be described and how they can compromise strength and eventually lead to bone fragility.
                Bookmark

                Author and article information

                Journal
                Geriatr Orthop Surg Rehabil
                Geriatr Orthop Surg Rehabil
                GOS
                spgos
                Geriatric Orthopaedic Surgery & Rehabilitation
                SAGE Publications (Sage CA: Los Angeles, CA )
                2151-4585
                2151-4593
                03 July 2019
                2019
                : 10
                : 2151459319859139
                Affiliations
                [1 ]Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA
                [2 ]Orthopaedic Trauma and Fracture Specialists, San Diego, CA, USA
                Author notes
                [*]Harmeeth S. Uppal, Orthopaedic Trauma and Fracture Specialists, 3750 Convoy Street, Suite 201, San Diego, CA 92111, USA. Email: harmeethuppal@ 123456gmail.com
                Article
                10.1177_2151459319859139
                10.1177/2151459319859139
                6610445
                31321116
                40659aae-22d2-4042-98cc-a82afb3542ef
                © The Author(s) 2019

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 11 February 2019
                : 26 May 2019
                : 27 May 2019
                Categories
                Resident Corner
                Custom metadata
                January-December 2019

                fragility fractures,hip fracture,geriatric trauma,hip fracture review,biomechanics

                Comments

                Comment on this article

                scite_
                0
                0
                0
                0
                Smart Citations
                0
                0
                0
                0
                Citing PublicationsSupportingMentioningContrasting
                View Citations

                See how this article has been cited at scite.ai

                scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

                Similar content89

                Cited by42

                Most referenced authors846