Fx Cadera: Tratamiento y Complicaciones

FRACTURAS DE CADERA Dr. Julio del Valle Aranda

Definición términos FRACTURA PELVIS Fx ACETÁBULO FRACTURA DE CADERA

Anatomía ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Anatom í a ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fracturas de cadera ,[object Object],[object Object],[object Object],[object Object],[object Object],ADULTO JOVEN 10% ADULTO MAYOR 90%

Fracturas del adulto mayor Osteoporosis ,[object Object],[object Object],[object Object],[object Object]

Fractura de Cadera ,[object Object],[object Object],[object Object],[object Object],[object Object]

Fracturas de Cuello de Fémur ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

FRACTURAS DE CADERA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Alta morbimortalidad ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

COMPLICACIONES Escaras de decúbito

Mortalidad-recuperación ,[object Object],[object Object],[object Object],[object Object]

Mecanismo ,[object Object],ENERGÍA OSTEOPOROSIS FRACTURA

Fracturas de cadera ,[object Object],[object Object],[object Object],1 2 3 Acetábulo

Fracturas de Cuello de Fémur ,[object Object],[object Object],[object Object],[object Object]

Clasificación de Garden I Fx Incompleta, o Impactada en valgo. II Fx Completa, no desplazada III Fx Completa, desplazamiento parcial IV Fx. desplazamiento total DESPLAZADAS NO DESPLAZADAS

Fracturas Cuello de fémur G I G II G III G IV

Necrosis avascular ,[object Object],[object Object],[object Object],[object Object],[object Object],Avascular Necrosis of the Femoral Head After Femoral Neck Fracture Fernando Gómez-Castresana Bachiller, MD, PhD*; Antonio Perez Caballer, MD, PhD**; and Luis Ferrández Portal, MD, PhD* CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 399, pp. 87–109 © 2002 Lippincott Williams & Wilkins, Inc ( Massie et al). 12 hrs o menos 25% Necrosis 13 a 24 hrs 30% “ 24 a 48 hrs 40% “ 1 semana 95% “

Clasificación Fx Laterales Cadera ,[object Object],[object Object],[object Object]

2.-FRACTURAS PERTROCANTÉRICAS TIPO II TIPO III TIPO I

FRACTURAS PERTROCANTÉRICAS TIPO IV TIPO V

Clínica ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnóstico ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Patologías concomitantes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Estudio preoperatorio ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TRATAMIENTO ,[object Object],[object Object],[object Object]

TRATAMIENTO TRAUMATOLÓGICO QUIRÚRGICO ,[object Object],[object Object],[object Object]

Preoperatorio Evidencia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Best Practices for Elderly Hip Fracture Patients A Systematic Overview of the Evidence. Lauren A. Beaupre, PT, PhD J GEN INTERN MED 2005; 20:1019–1025.

Perioperatorio Evidencia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Best Practices for Elderly Hip Fracture Patients A Systematic Overview of the Evidence Lauren A. Beaupre, PT, PhD J GEN INTERN MED 2005; 20:1019–1025

Mortalidad y momento de cirugía Solo en pacientes sin comorbilidad se podría retrazar 4 días Mortalidad posterior fractura 30 DIAS 10% 1° AÑO 33% 3° AÑO 51-57% Early Mortality After Hip Fracture: Is Delay Before Surgery Important? BY CHRISTOPHER G. MORAN, MD, FRCS(ED), RUSSELL T. WENN, BA, MANOJ SIKAND, MS, FRCS, AND ANDREW M. TAYLOR, DM, FRCS

Fracturas Laterales de Cadera Tratamiento Quirúrgico ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Tratamiento ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Extracapsular hip fracture fixation: Comparison of different extramedullary fixation implants (fixed nailplates, RAB-plate, Pugh nail, Medoff plate, sliding hip screw). Cochrane Review. Cochrane Lybrary, Issue 4, 1998. Oxford.

Tratamiento ,[object Object],[object Object],[object Object],[object Object],Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degree screw-plate: a prospective, randomized study. Sadowski C, Lubbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P. J Bone Joint Surg Am. 2002;84:372-81.

Tratamiento ,[object Object],[object Object],[object Object],[object Object],[object Object],Parker MJ, Handoll HHG. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD000093. DOI: 10.1002/14651858.CD000093.pub3 .

Tratamiento ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Parker . Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD000093. DOI: 10.1002/14651858.CD000093.pub3.

Fracturas Trocantéricas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Montaje mesa ortopédica c/ Rx D.H.S.

Según estabilidad largo placa

Fracturas Mediales de Cadera Tratamiento QUIRÚRGICO ,[object Object],[object Object],[object Object]

Fractura subcapital Jóvenes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

FRACTURAS SUBCAPITAL >60a PRÓTESIS DE CADERA ,[object Object],TOTAL PARCIAL >75-80 años 60-80 años

INDICACIONES PPC ,[object Object]

Artroplastía parcial de cadera

Indicaciones PTC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

FIJACIÓN Cementada No cementada

Artroplastías totales de cadera ,[object Object],[object Object],[object Object]

Prótesis Autobloqueante Cementada

POSTOP PTC Cojín Colchón Medias DVT

Fx Cadera: Tratamiento y Complicaciones

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