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Noon.ortho
- 1. NOON CONFERENCE EXT. NATTAWAN MEEPRASERTSAGOOL
- 3. TEXT PRESENT ILLNESS ▸ 5 ชั่วโมงก่อนมารพ. ขณะผู้ป่วยเดินอยู่ในบ้าน เดินะดุดขาพันกันล้ม สะโพกและขาซ้ายกระแทกพื้น ศีรษะไม่กระแทกพื้น ไม่สลบ จำ เหตุการณ์ได้ หลังล้ม มีอาการปวดสะโพกซ้ายและหลังขาซ้าย ขาผิด รูป เดินไม่ไหว ไม่มีชาหรืออ่อนแรง ไม่ปวดหลัง
- 4. TEXT PAST HISTORY ▸ Underlying DM, HT, IHD s/p PCI ▸ Denied smoking history ▸ Denied alcohol drinking ▸ Denied food and drug allergy
- 5. TEXT PERSONAL HISTORY ▸ Current medications ▸ Clopidogrel (75) 1 tab po pc od ▸ Simvastatin (10) 1 tab po hs ▸ Cavidilol (12.5) 1 tab po pc od ▸ HCTZ (25) 0.5 tab po pc od
- 6. TEXT PRIMARY SURVEY ▸ A: can speak, no c-spine tenderness ▸ B: spontaneous breathing, normal breath sound, equal both lungs, no adventitious sound ▸ C: BP 153/78mmHg, PR 98 bpm, no active bleeding ▸ D: E4V5M6, pupils 2 mm RTLBE ▸ E: external rotation of Lt hip, no external wound seen, no ecchymosis
- 8. TEXT PHYSICAL EXAMINATION ▸ Vital signs: T 37.4 c, BP 153/78 mmHg, PR 98 bpm, RR 20/min ▸ General appearance: A Thai female good conscious, well cooperate ▸ HEENT: normal skull contour, no wound seen, pale conjunctiva, anicteric sclerae ▸ CVS: full regular symmetry pulses all extremities, normal s1s2, no murmur, capillary refill < 2 sec ▸ Respiratory: normal breath sound, equal both lungs, no adventitious sound ▸ Abdomen: soft, not tender, no rebound tenderness, no guarding ▸ Pelvis and Perineum: no perineum wound, no bleeding per rectum/urethra/vagina, pelvic compression test negative both sides ▸ Extremities: external rotation of Lt hip, shortening, no external wound seen, no ecchymosis, limited ROM of due to pain, DPA 2+, PTA 2+
- 9. TEXT INVESTIGATIONS ▸ Film both hip AP ▸ Film Lt knee AP, lateral view ▸ Film Lt femur AP, lateral view
- 13. TEXT PROBLEM LIST ▸ Closed fracture Lt neck of femur ▸ Underlying DM, HT, IHD s/p PCI
- 15. TEXT ARTERIAL SUPPLY OF THE FEMORAL HEAD AND NECK
- 16. TEXT INTRACAPSULAR VS EXTRACAPSULAR HIP FRACTURES
- 17. TEXT NECK OF FEMUR FRACTURE ▸ Femoral neck fractures are intracapsular ▸ Tend to occur in elderly patients who fall ▸ In young individuals, generally occur as a result of major trauma
- 18. TEXT MECHANISM OF INJURY ▸ A fall directly onto the lateral hip ▸ A twisting mechanism in which the patient’s foot is planted and the body rotates ▸ A sudden spontaneous completion of a fatigue fracture, which then causes a fall ▸ Major trauma in younger patient: a motor vehicle collision, a fall from a height
- 19. TEXT SYMPTOMS AND EXAMINATION FINDINGS ▸ Sudden onset of hip pain ▸ Inability to walk ▸ Groin pain if displaced hip fracture is involved ▸ Externally rotated and shortened ▸ Little bruising
- 20. TEXT INVESTIGATIONS ▸ Film both hip ▸ AP ▸ AP with maximal internal rotation ▸ Lateral cross table view ▸ Pelvis AP lateral view
- 21. TEXT NORMAL ANGLE ▸ The femoral neck - the femoral shaft (AP) : 45 ▸ The medial femoral shaft - the trabecular lines running through the shaft to the femoral head: 160 - 170
- 25. TEXT MANAGEMENT ▸ Initial management ▸ Immobilization: skin traction, splint ▸ Definite management ▸ Conservative treatment ▸ Surgery ▸ Close or open reduction with multiple screws fixation ▸ Hemiarthroplasty or total hip replacement
- 26. TEXT BEFORE SKIN TRACTION… AFTER SKIN TRACTION…
- 27. TEXT COMPLICATIONS ▸ Infection ▸ Chronic pain ▸ Dislocation ▸ Delayed union or nonunion or malunion ▸ Avascular necrosis ▸ Posttraumatic arthritic changes
- 28. TEXT AVASCULAR NECROSIS OF THE FEMORAL HEAD ▸ History: Pain with insidious onset that is worse with weight bearing; recent trauma or corticosteroid use ▸ Signs: Pain with all hip motions, antalgic gait ▸ Tests: Radiography, MRI ▸ Management: Surgery or closed observation by an orthopedic surgeon
- 29. THANK YOU Ext. Nattawan Meeprasertsagool TEXT