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Orthopaedics
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Once a hip fracture is suspected analgesia should be given. Options include paracetamol, opioids or nerve blocks (e.g. femoral nerve blocks) prior to surgery. Extracapsular fractures are not at risk of avascular necrosis and are usually treated with internal fixation with either an extramedullary plate or an intramedullary nail.Patients with a non-displaced intracapsular fracture and no comorbidities may also be treated with internal fixation. If patients do have major illness or advanced organ-specific disease, then a hemiarthroplasty is offered.Patients with a displaced intracapsular fracture are treated with either a total hip replacement or a hemiarthroplasty.Patients should be offered a total hip replacement if they were able to walk independently prior to the fall, have no cognitive impairment and are medically fit for the procedure.
Management of osteoporotic proximal intertrochanteric/subtrochanteric femoral fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Avadhoot Kantak, George Tselentakis
Approximately 60% of fractures of the hip in the elderly are intracapsular (17). Intracapsular fractures occur about three times more often in women. The highest rates were found among white women. Extracapsular fractures also occur in a 3:1 female-to-male ratio. Subtrochanteric fractures show a bimodal distribution (20–40 years and over 60 years) (18).
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
Intracapsular fractures are further broken down into whether they are displaced or undisplaced. Undisplaced intracapsular fractures are generally stable and interruption of the blood supply to the femoral head is rare. Therefore, treatment is aimed at ensuring the head fragment does not displace during rehabilitation. This can be achieved with cannulated screws inserted along the femoral neck into the head.
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].