Summary: I'm joined by Mo Sarraj (PGY-2) to discuss hip fractures. Learning objectives are (1) accurately classify fractures of the proximal femur, (2) describe treatment options for each fracture type, (3) understand landmark RCTs in hip fracture management, (4) learn high-yield pearls for managing hip fracture patients in residency.
Timestamps:
1:15 - Background (Hip Fractures)
1:30 - Assessment
2:45 - Anatomy
4:05 - Diagnosis
5:45 - Femoral Neck Fracture (FNF) Classifications
6:20 - Pauwel's Classification
7:05 - Garden Classification
7:40 - FNF Treatment
8:30 - Stable FNF Treatment Options
10:15 - Assessing Intraoperative Reduction
11:00 - Cancellous Screw ORIF
14:45 - Sliding Hip Screws
15:00 - FAITH trial
16:05 - Unstable FNF Treatment Options
17:30 - Hemiarthroplasty vs THA
18:20 - HEALTH trial
18:50 - Intertrochanteric Fractures (ITF)
19:30 - ITF Classification
21:35 - ITF Treatments
23:10 - Subtrochanteric Fractures
24:00 - Clinical Scenario & Practical Tips
30:10 - Summary
Resources:
Hip Fracture Management Summary Paper (NEJM, 2017): https://www.nejm.org/doi/10.1056/NEJMcp1611090
HIP ATTACK (Lancet, 2020): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30058-1/fulltext
FAITH (Lancet, 2017: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30066-1/fulltext
HEALTH (NEJM, 2019): https://www.nejm.org/doi/full/10.1056/NEJMoa1906190
Intertrochanteric Fracture Treatment Biomechanics (IJO, 2015): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443419/
OrthoBullets: https://www.orthobullets.com/trauma/1037/femoral-neck-fractures & https://www.orthobullets.com/trauma/1038/intertrochanteric-fractures