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Orthopaedics
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Extracapsular fractures: are subdivided as basi-cervical, intertrochanteric and subtrochanteric. Unlike intracapsular fractures, they are not associated with a significant risk of AVN. Management: can be conservatively with traction or more commonly, surgically with internal fixation, i.e. cannulated screws.
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Hip fractures extend from the head of the femur to just below the lesser trochanter, and may be classified in relation to the hip joint capsule being intra-capsular or extra-capsular. Intracapsular fractures may be below the head of the femur (subcapital), across the mid-femoral neck (transcervical) or across the base of the femoral neck (basicervical). Extracapsular fractures are outside the hip capsule and include intertrochanteric and subtrochanteric fractures. Strictly speaking, extra-capsular fractures do qualify as neck of femur fractures.
Extremity trauma
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
If the fracture is extracapsular, vascularity of the head is not an issue. Extracapsular femoral neck fractures are subdivided into stable or unstable. Unstable fractures include a reverse oblique pattern or where the medial calcar is comminuted (lesser trochanter) fracture. Stable extracapsular fractures simply require connection of the head to the shaft, often using a dynamic hip screw (Figure28.23).
Exercise interventions, physical function, and mobility after hip fracture: a systematic review and meta-analysis
Published in Disability and Rehabilitation, 2022
Xiaorui Zhang, William J. Butts, Tongjian You
Resistance training with a progressive load of 60–80% of 1RM seemed to be a good choice. 1RM is the maximum amount of load or weight that a person can only lift for one repetition. Similarly, a previous study found that a load of 80–95% 1RM worked best for hypertrophy [60], and a meta-analysis suggested that 60% of 1RM should be the most effective load for untrained people with training 3 days per week, whereas for trained people it should be 80% of 1RM with training 2 days per week [61]. It also appears that progressive resistance exercise is an effective and determining intervention factor for physical function promotion. There are several possible explanations for this result. Sarcopenia is both a cause and a very common consequence of hip fracture [62]. As a factor that has a strong relationship with lower-extremity physical function, muscle quality can be significantly enhanced by resistance exercise [63–65]. For surgical complications of hip fractures, especially for extracapsular fractures, they are almost always linked to load-bearing activities and have a close relationship with lack of muscle quality and bone quality [66]. A more profound and specific effect could be provided by resistance exercise compared to aerobic exercise [67]. Meanwhile, pain is present during the weight-bearing time and strongly associated with lower-extremity physical function [68], yet no pain or light pain was reported during and after resistance training time [69].
Are extracapsular and intracapsular hip-fracture patients two distinct rehabilitation subpopulations?
Published in Disability and Rehabilitation, 2022
Avital Hershkovitz, Tal Frenkel Rutenberg
Fragility hip fractures are classified as either intracapsular (AO 31B) or extracapsular (AO 31A) [4]. These fractures are further classified according to their level of cortical continuity and comminution. When operating on extracapsular fractures, simple fractures (31A1) can be treated with a dynamic hip screw procedure for fracture fixation, whereas, multi-fragmentary fractures (31A2 and 31A3) are usually treated with intramedullary nail fixation. As for intracapsular fractures, the favored treatment option is hip replacement surgery (either partial or complete). The rationale for performing surgery following a fragility hip fracture is to allow early mobilization, and prevent pain and complications caused by bedrest, such as pneumonia, delirium, decubitus ulcers, venous thromboembolic events, loss of muscle strength, and independence [5,6]. Yet, even with timely surgery, hip fractures result in a major decline in quality of life during the post-operative year [7], with less than 50% of patients regaining their previous level of function [8].