???? ????? HIP FRACTURES

1
???? ?????HIP FRACTURES

• ????????? ??? ????
• ???? ????? ?????

2
???? ????? ?? ?????? ?? ???? ??????? ???????
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??? ?????? ???????? ???

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• ?????????????????? ??? ??????? ?????? ????
  ??????? ???????? ???? ???? ??? ?? ?? 18 ????????
  ???????? ??????? ?? ??? ?????? ??? ????? ?????
  ???? ???? ????? ???? ?????? ?? ???? ?????? ?????
  ??????(ludlof )
• ?????? ????? ????? ?????? ?? ?????? ???? ???????
  ?????? ??? ????? ????? 90 ?? ?????? ??? ?????
  ??????

3
(No Transcript)
4

• ????????????????????? ????? ??? ??? ????? ???
  ??????
• ?? ???????? ???? ??????? ??????? ???????? ??????
• ??????????? ??? ?????? ????? ???? 6??????
• ????? ????? ???? ?????? ?????? ???????
  ???? ????? ?????? ?????
• ????? ???? ??????????????????? ??? ??? ??????
  ????????? ???????? ????? ????????????? ????????
  ??? ??? ??? ??? ???????? ?CT?? MRI

5
(No Transcript)
6
???? ??? ???????? ????? ????? ???????? ??
??????? ??????? ?? ????? ???? ??????? ???? ?????
??? ????? 5?? ???? ?????? ??????

• ???? ?????????65??? ??? ???? ?????? ??? ???? ???
  ?????? ??? ???? ??????
• ?????? \?????? 3
• ???? ??????? 15-20
• ???? ?????? ?????? ???? ????? ??? ????? ????
  ?????? ??? ???? ????? ????? ????? ???? ??????? ??
  ????? ???????? ???????? ??? ???????? ????
• ???? ?? ????? ??? ????? 24???? ?? ??? ???????
  ?????? ?????? ??????

7

• ??????
• ??? ?????? ????? ?????
• ??? ???? ?????? ??? ?????
• ???? ???? ??????? ???? ?????? ??? ???????

8
???????

• ??? ????
• ????1?? ????? ???? ??? ??? ???? ??? ???????? ??
  ?????? ?????? ??? ?????? ?????? ???? ???? ???
  ???????? ?????
• ????2??? ????.?? ????? ??????? ???? ??? ??? ????
  ??? ???????? ?? ???? ?????? ?? ????????????? ???
  ???? ?????? ???????
• ???? ?? ????????? ????? ??? ?????? ????????
  ??????? ?? ???? ??? ???????? ??? ?? ????1???? ??
  ??? ????? ?? ??????? ?????? ????? ???? ?? ??? ???
  ?????? ????????

9

• ????3?? ???? ??? ?????? ???? ????? .?? ??? ????
  ??? ??????? ??????? ????? ????? ???? ??????
  ?????? .?? ???? ?????? ??????
• ???? ??????????? ???? ????? ??????? ????? ???????
• ????4?? ??? ????? ???????? ? ??????? ???????
  ????? ?? ??? ?? ??????? ??? ????? ?????? ??
  ??????? ?????? ??? ??????? ????? ?? ??? ?? ??????
  ???????? ??????? . ??? ?? ???? ???? ???????
  ???????? ??????? ??????????
• ???? ???? ???? ?????? ???? ????? ?????? ????????
  ??? (??? 3?4) ???? 1\3 ???? ??? ???????? ??? ????

10
(No Transcript)
11

• ??? ?????? ???? ??? ???????? ??? ????? ???? ?????
  ??? ??? ?????? ??? ??????? ??? ???? ???? ???????
  ???????? ???? ??? ?????? ?? ???? ?? ????????
  ????? ?? ?????? ???? ???????? ??? ??????
• ?????? 1?? ????? ???? ?????? ??????? ?? ??????
  ??????
• ??????2?? ????? ???? ?????? ??????? ?? ??????
  ??????
• ?? ?????? 2 ???? ??? ?????? ?????? ????? ????
  ???? ????? ???? ??? ?? ??????? ???????

12
(No Transcript)
13
(No Transcript)
14

• ???????? A1
  ??? ???? ?????
  
• 
  ???????? A2 ??? ???? ??? ??????? ?? ???? ??
  ????? ??????
• ???????? A3 ???
  ???? ????? ?????? ?????

15
(No Transcript)
16
???????? ????????

• ???????? ???????? ??????? ??? ??? ???????? ???
  ??????? . ???? ????? ??????? 34?? ????????
  ???????? ????? 17????? ???? ????? ????????
  ???????
• ????? ???? ???? ?????? ??????? ?????? ???
  ????????? ?? ?????? ????? ????? ???? ??????

17
???????? ????????

• ????? ??????? ???????? ?? ????? ??? ???? ????
  ?????
• ???????? ??????
• ??? ???? ?????? ????? ??? ???????? ????? ????
  ???? ?? ?????? ?????? ?? ?????(quality)????? ???
  ?? ??????? ?? ??? ??? ?? ????? ??? ?? ???? ????
  ??????? ??????? ?? ??? ????? ?????? ??? ???? (
  ????? (quality???? ?? ????.
• ????? ???? ??? ???? ???????? (????????)

18
???? ???????? (????????)

• ?? ???? ???? ???????? ???? ???? ?????
• ????? ?????? ?????? ?? ?? calcar? ?????? ?????
  ??? ??? ??? ????? ?? ??? ?????
• ???? ??? ????? ??? ?? ??????? ??????? ?????? ???
  ????? ?????? ?????? ????? ??? ?????? ?????? ???
  ?? ????? ??????
• ??????? ???????? ????? ???? ?? ??????? ???????
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  ?????? ?????? ?????? ????? ??? ?????? ????? ??
  ??? ????? ????? ?????
• ?? calcar ?? ????? ????? ???? ??????? ??????
  ?????? ?????? ???? ????? ????? ????? ?? ??? ???
  ???

19
???? ???????? (????????)

• ????? ??? ??? ?? ????? ????? ???? ?? ???? ??
  ??????? ??????? ??????? ????? ?? ???? ?? ?????
  ??????? ??????
• ??? ???? ???? ????? ??? ?? ???? ????? ???? ????

20
(No Transcript)
21
????

• ???? ????? ?? ????? ??? ????? ???????????? ????
  ??????? ??????? ?? ?? ????? ???? ?????? ?????
  ????
• ???? ?????? ?? ???? ??? ?????? ???????? ???????
  ????? ??? ?????? ??????? ????? ??? ????? ??????
  ??? ?????? ????????
• ?????? ?????? ??? ?? ???? ???? ???? ????? ??????
  ??????
• ??? ??? ???? ???? ????? ?????? ?????? ??????
  ????? ??? ?? ??????? ????? ???? ???????? 100
  ???? ??? ?????? ??? ?? ???? ???? ??????

22
????

• ??? ????? ??????? ???? ?????? ??????? ??????? ??
  ?????? ??????? ??? ???? ????? ?? ??????? DHS
  ????? ??? ??????? ? Dimon-hugstone
• ?? ??? ???? ??? ?????? ??????? ?????? 45 ????
  ?????? ?????? ????? Sarmiento

23
(No Transcript)
24
(No Transcript)
25
??? ?? ????????? ????????? ?????? ???? ???
????????

• ???? ???? ?????? ???????? ???? ??? ????????
  ???????? ??????? ???
• ????? ??????? ???? ????? ???? ????? ??????
  ????????? compression hip screw medoff
  sliding plate - ????? ?? -Plate L
• ?????? ??????? ??? ????? cephalomedullary nails
  with two screws , Condylocephalic nails

26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
?? ??? ??????

• ???? ?????? ??????? ?? ???? ?? ????? ??????
  ???????
• ???? ???????? ???????
• ????? ??? ????? ?????? ??? walker ??? ?????
  ??????? ??????? ???? ??? ??????
• ???? ??? ????? ???? ????? ??? 6 ?????? ?? ??????
  ??? ???????

32
???? ??? ????????

• ?? ?????? ???? ???? ??? ?????? ?????? ?????
  ???????? ?? 2-3 ??? ???? ?????? ??????
• ?????? 10-34 ?? ???? ?????
• ??? ????? ???? 20-40 ????? ?? 60
• ????? ??? ???? ?????? ??? ?????? ???? ?? ???? ???
  ?????? ??? ?????? ??????
• ???? ??????? 8,3-20,9
• ?????? ????? ???? ??? ????????
• ???? ??? ?????? ???? ????? ?? ??? ???????? ????
  ????? ????????? ??? ??? ????? ??????? ??????? ???
  ??? ???????

33
???????

• ??????? ???? 3-4 ?? ???? ??? ????????
• ??? ????? fielding ?????? ??? ??????? ??????
  ???????? ?????? ??? ????????
• ????? 1 ??? ?? ????? ?????? ??????
• ????? 2 ??? ??? 2,5 -5 ?? ???? ?????? ??????
• ????? 3 ??? ??? 5-7,5 ?? ???? ?????? ??????

34
???????

• ??? ??? ??? ????? ????? ?? ????? ????? ???? ??
  ????? ???? ???? ??? seimsheimer ???
• ????? 1 ??? ??? ????? ?? ???? ??? ?? 2 ??
• ????? 2 ??? ??????
• 2-1 ?? ??? ?????
• 2-2 ?? ??? ?????? ??????? ?????????? ??
  ?????? ???????
• 2-3 ?? ??? ?????? ??????? ?????????? ??
  ?????? ???????

35
???????

• ????? 3 ??? ???? ???
• 3-1 ?? ??? ?????? ?????? ?????? ??? ??
  ?????? ???????
• 3-2 ?? ??? ?????? ?????? ??????? ????
  butterfly fragment
• ????? 4 ??? ???? ???? ??? ?? ????
• ????? 5 ??? ??? ???? ??????

36
(No Transcript)
37

• ?? ???? ?????? ????? ?????? ??????? (?????? ?????
  ??? ????? ?????? second-generation intramedullary
  nails,) ???? ????? Fielding and Seinsheimer ???
  ????? ???? ?? ???? ????? ????????? ??? ?????
  ????????? ??????? ???? ??????
• ?????? ????? ????? ????????? ?????? ??????
  ??????? ????? ????? ??? ?????? ?????? ?????
  ??????? ???????? ???? ????????? ?????????
  ???????? ?? ??????

38
????? Russell - Taylor

• ????? 1????? ?? ???? ??? ??????? ????????
• 1-a ???? ????? ??????? ???? ?? ???? ??????
  ??? ???? ?????
• 1-b???? ?? ????? ??????? ?????? ??????
  ???????
• ????? 2 ??? ??? ??? ??????? ????????
• 2 a??? ???? ??? ?????? ?????? ??? ???
  ???? ??? ???
• 2-b ??? ???? ??? ?????? ?????? ?? ???? ???
  ???

39
????? Russell - Taylor
40
????? ???? ??? ????????

• ???? ???? ??????? ?????? ???? ??? ????????
  ????????? ??? ????? Russell Taylor
• ???????? ??????? ???? ?? ???? ????? ????? ??
  ????? ??????? ????????
• ? chs ??????? ????? ??????

41
(No Transcript)
42
(No Transcript)
43
???? ??? ?????

• ???? ???????
• ???? ??? ??? ????? ??????? ?????? ????? ????? ???
  ???? ??? ?????? ????? ???? ????? ?????
• ?? ???? ????? ?????
• ??? ?? 60??? ?????? ???? ??? ??60 ?????? 3
  ????? ??????

44
??????

• ??? ?????
• ???? ????? ????? 30 -40 ???? ??? ?? ???? ????
  ???? ???????
• ??? ?????? ?? ?????
• ??? ???????? ????????
• ??? ???? ???????? ?? ?????? ?????????

45
??????

• ???? ?? ????? ??????
• ??? ???????? ???????? (???? ????? )
• ???? ????? ?? ??????? ????? ???? ????????
  ??????? ????? ?????? ?????? ????? ??????
• ??? ?????? ???????? ??????? 160-180
• ???????? 180

46
(No Transcript)
47
(No Transcript)
48
(No Transcript)
49
????? ?????

• ???? ?? 3 ???????
• ???? ??????? ???? ??????? ??? ????? ??? ?????
  ?????? ????? ?????? ??? ???? ??????? ??????
  ??????? ?????? ?????? ?? ??????? ??????
  ??????? ??????
• ?????? ??????? ??????? ?? ?????? ????????? ???
  ??? ????? ??? ??????? ?????? ????? ????? ?????
  ?????? ???????
• ????? ?????? ??????

50
(No Transcript)
51
???????

• ????
• ?? ????? ???? ?? ?? ????? ????? 30
• ?? ????? ???? ?? ?? ????? ????? 30-50
• ?? ????? ???? ?? ?? ????? ????? 50-70-90
• ??????? ???? ??????? ????

52
????
53
???????

• ????? 1?? ????? ??? ???? ????? ????? ????????
  ?????? ?????? ???? ????? ???? impact fracture

54
(No Transcript)
55

• ????? 2 ??? ???? ??? ?????

56
(No Transcript)
57

• ????? 3 ??? ???? ?????? ????????? ????? ?????
  ??? ????? ?? ??????

58

• ????? 4 ??? ???? ????? ???? ??? ???? ??????
  ????? ??????? ?? ?????? ????? ?????

59
(No Transcript)
60
Classification
1961
Garden
61
Classification
62
????? AO

• B1 subcapital with no or minimal displacement
• B2transcervical
• B3displaced subcapital fractures

63
Classification
A O
MullerNazarian
Common universal language
1979
3 1
B2 3
31B23
64
Classification
Molé
Particular case

• rare
• Young patient
• Violent trauma

65
????

• ????? ???? ??? ??? ??? ??????? ?? ?????
  
• ???? ?????? ?????Lead better
• ??? ????? 90 ?????? ????? ?????
  ????
• ????? ?? ??? ??? ?? ?????
• ????? ?? ???????? ??? ???????
  ???????
• ??? ????? ??????
• ?????? heel-palm"

66
????

• ???? ?????? Whitman
• ?? ? ????? ??????
• ?? ???? ???????? ??????? ? ???????
• ?? ????? ?????? ?????
• ???? ?????? ??? ????? ?????? ????? ????? ????????
  ??? ????? ????? ?? ???? ????? ?????? ?? ????? ???
  ??????? ?????? ???? ??????? ??????? ?? ????
  ???????20 ???? ? ????? ???????? ??????? ?? ????
  ?? ???? ?????? ??? ??? ???? ?? ??????? ????? ??
  ???? ??????? ??????? ??? ???? ??????? ????????
  ??????? 20-30 ????

67
????? ????

• ??????? ??? ???? ??????
• ??? ?????? ???????? ???? ??????? ?????? ???
• ??? ?????? ???????? ??????? ?? ??????? ????? ????
  ???????? ?? ??????? ??????? ??????? ????? ??????
• ??? ???? ?????

68
(No Transcript)
69
???????

• ????? ???????
• ??? ?? ???? ??????? ???? 24 ???? ????? ??? ?????
  (?????? ?????? ?????? ???? ???? )
• ??????? (??????? ?????? )??? ???? ?? ???? ????
  ??????? ??? ????? ???????

70
???????

• ?????? ??? ???????? (????? 1-2 )
• ????? ???????
• ??? ?? ???? ??????? 20 ?????
• ????????
• ????? ????? ?????? Multiple screw fixation
• DHS ?????? ????? ????? ????? ??? ????? ????? ????
  ???????
• ????? ?????? (Bi-polar- Uni-polar- Total hip
  arthroplasty )

71
Treatment

• Internal fixation
• Multiple screws
• Treatment of choice

72
Treatment

• Sliding hip screw
• Optimal for basicervical fractures
• Behave as
• Extr-acapsular

73
Uni-polar prosthesis
Thompson
Austin-Moore
74
Bi-polar prosthesis
75
??????????

• ???????? ???????? ?????? ??????????
• ??? ???????? ????? ?????? ??????? ?? ??????
  ????? ??? ????? ?? ????? ????? ?????? ???????
• ?????? ???????? ??? ??????? ?????? ??? ??? ??
  ???? ???? ????? ??????
• ?????? ??????? ???????

76
??? ????????

• 4 ????? ??????? 84
• Sliding hip screw ? 64
• Garden I 1 Garden III
  IV 25
• Vertical fracture 40 non-union

77
ComplicationNon union
78
Complication

• Treatment of non-union
• In active patients valgus osteotomy

79
??????????

• ?????? ?????????? ??????
• ???? ???? ?????? ?????? ???? ?????
• ?????? ????? ???? ??????? ???? ????? ?????? ?
• ???? ?????? ?????? ???????? ?????

80
ComplicationAvascular necrosis
Garden I
Post-operative
Late avascular necrosis
81
Complications

• Loss of fixation
• Poor screw position

82
ComplicationProtrusion of screws(AVN)
83

• Stress fracture

84
(No Transcript)
85
MoKazem.com

• ??? ???????? ?? ?? ????? ??????? ?? ??????? ?
  ??????? ?? ??? ??????? ???????? ?? ???? ???????
  ??????? ?? ???? ????, ??? ????? ?. ???? ??????.
• ?????? ??? ????? ?? ??????? ??????? ?? ???
  ????????.
• This lecture is one of a series of lectures were
  prepared and presented by residents in the
  department of orthopedics in Damascus hospital,
  under the supervision of Dr. Bashar Mirali.
• This site is not responsible of any mistake may
  exist in this lecture.

?. ???? ????
Dr. Muayad Kadhim