1. HIP FRACTURES
Dr. Deepa Abichandani

2. Overview
Incidence is highest in >65 years of age but also in young adults due to RTA
F>M
Two types: intracapsular and extracapsular

3. Anatomy Of Hip Joint

4. Blood Supply Of Femur
Intracapsular fractures are at risk of non union and avascular necrosis due to interruption of the blood supply to the femoral head via cruicate (med and lat circumflex) and intramedullary vessels

5. Classification Of Femur fracture
Intracapsular:
Subcaptial
Transcervical
Basicervical
II. Extracapsular:
Intertrochanteric
subtrochanteric

6. Garden Classification
Garden I: incomplete fracture of the femoral neck
Garden II: complete fracture without displacement
Garden III: complete fracture with partial displacement
Garden IV: complete fracture with full displacement

7. Pauwels Classification

8. Intertrochanteric Fracture
Common MOI  result of fall (direct / indirect)
Occurs along the line of greater and lesser trochanter.
An extracapsular fracture.
Classified by Evans as stable or unstable
Most commonly used classification is Jensen where type 1&2 are stable and 3-5 are unstable

9. Intertrochanteric Fracture

10. Intertrochanteric Fracture (JensenClassification )

11. Sub-trochanteric Fractures
Common MOI  trauma to the area between the lesser trochanter and 5 cm distal to it.
Commonly used classification  Seinsheimer classification.

12. Sub-trochanteric Fractures (Seinsheimer classification)

13. Intracapsular Fractures
Subcapital Fracture
Transcervical Fracture
Basicervical Fracture

14. Subcapital Fracture

15. Transcervical Fracture

16. Basicervical Fracture

17. Post-Operative Rehabilitation
Maximum Protection Phase :
Prevent vascular & pulmonary complications
Improve strength of upper limbs & unaffected lower limb.
prevent post-operative reflex inhibition of hip & knee musculature.
Restore active mobility & dynamic control of the affected hip & adjacent joints.

18. Post-Operative Rehabilitation
Moderate & Minimum Protection Phase :
Increase flexibility of any chronically shortened muscles.
Improve strength & muscular endurance in the lower extremities for functional activities.
Improve postural stability and standing balance.
Increase aerobic capacity