A hip fracture is a life-changing event, not only for the patient but also for their family, friends, and companions. It is increasingly recognized that hip fractures pose not only a personal cost but also a significant societal cost because of the morbidity and mortality that tends to accompany fractures of the proximal femur. For too long the emphasis on hip fracture management has been exclusively surgical. Though no one disputes that a well-performed operation is essential for patient recovery, there are many aspects of hip fracture care that need to be addressed in order to maximize the outcome for the patient. This book attempts to address these other significant issues while providing the most current recommendations regarding the surgical management of fractures of the proximal femur.
In this text we define the scope of the problem and then detail for the reader the most current information regarding the prevention and treatment of osteoporosis. Orthopaedic surgeons have an obligation to learn more about osteoporosis and become actively engaged in the treatment of patients who have this condition and come to their attention as a consequence of a proximal femoral fracture. In addition, we address the appropriate medical assessment of these patients and provide insight into current methods for treatment of the common comorbidities found in these older patients. Radiology, anesthetic techniques, and postoperative pain management are all addressed in separate chapters.
Detailed surgical techniques for femoral neck fractures, intertrochanteric fractures, and subtrochanteric fractures are provided in a comprehensive fashion and are illustrated by diagrams, photographs, and radiographs. The important aspects of postoperative management—including common postoperative complications, delirium, and dementia—are all covered as well, as is a structured rehabilitation program.
I believe that this book is the most comprehensive text currently available for hip fracture management and that, by implementing the recommendations contained herein, outcomes for proximal femoral fractures indeed will be improved.
-- James P. Waddell, MD, FRCSC
Key Features
- Review surgical techniques such as pinning, plating/intramedulary devices, and total hip replacement implants, and get a greater understanding of deep vein thrombosis and pulmonary embolism prevention.
- Brush up on related topics including epidemiology, osteoporosis, co-morbidities, evidence-based post-op, and rehabilitation protocols.
- Get the advice of expert contributors worldwide who detail best practices in prophylaxis, surgical technique, and rehabilitation.
Website Features
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Contents
Section I - Introduction
Chapter 1 - Epidemiology/Population Studies: Scope of the Problem
- Frailty
- Falls and Fractures
- After the Fracture
- Summary
- References
Section II - Preoperative Assessment of the Hip Fracture Patient
Chapter 2 - Skeletal Assessment of Fractures of the Proximal Femur
- Radiologic Evaluation
- Special Types of Fractures
Chapter 3 - General Assessment and Optimization for Surgery
- Medical Assessment of a Patient with a Hip Fracture
- Epidemiology and Outcome
- Perioperative Complications
- Optimal Timing of Surgery
- Determinants of Perioperative Risk
- Cardiac Risk Assessment
- Cardiac Risk Optimization
- Etiology of the Fracture
- Pulmonary Risk Assessment and Optimization
- Diabetes Management and Optimization
- Liver Disease Assessment and Optimization
- Perioperative Renal Dysfunction and Optimization of the Patient with Renal Disease
- Dementia and Delirium
- Prevention of Venous Thrombosis and Thromboembolism
- Anticoagulant Management
- Antiplatelet Agent Management
Section III - Anesthesia and Pain Management
Chapter 4 - Regional versus General Anesthesia for Fractures of the Proximal Femur
- General Anesthesia
- Regional Anesthesia
- Special Considerations
Chapter 5 - Improving Pain Management and Patient Outcomes Associated with Proximal Femur Fractures
- Pain, Acute Pain, and the Prevention of Chronic Pain
- Multimodal Balanced Analgesia
- Undertreatment of Pain
- Assessment of Pain
- Pharmacotherapy: Drugs Commonly Used in Multimodal Analgesia
- Regional Anesthesia and Pain Control
- Optimizing Pain Management
Section IV - Surgery
Chapter 6 - Femoral Neck Fractures: Reduction and Fixation
- Defining the Injury
- Classification
- Diagnosis
- Treatment Options
- Nonoperative Treatment
- Operative Treatment
Chapter 7 - Femoral Neck Fractures: Arthroplasty
- Indications
- Imaging
- Treatment Options
- Surgical Technique
Chapter 8 - Combined Fractures of the Hip and Femoral Shaft
- Incidence
- Mechanism of Injury and Pathophysiology
- Initial Diagnosis and Assessment
- Management Options and Controversies
- Improving Outcomes
- Areas of Uncertainty
- Complications
Chapter 9 - Femoral Neck Fractures: Treatment of Nonunion
- Diagnosis and Preoperative Considerations
- Salvage Procedures
Section V - Intertrochanteric Fractures
Chapter 10 - Trochanteric Fractures: Sliding Hip Screw
- History
- Construction and Biomechanics
- Indications
- Preoperative Planning
- Surgical Technique
- Postoperative Management
- Specific Complications
Chapter 11 - Trochanteric Fractures: Intramedullary Devices
- Aims of Treatment
- Rationale for Intramedullary Nailing of Extracapsular Hip Fractures
- Indication and Fracture Types
- Operative Technique
- Postoperative Management
- Implant Removal
- Pitfalls of Intramedullary Devices
- Next-Generation Cephalomedullary Nails
Chapter 12 - Complications of Trochanteric Fractures
- Overview of Complications
- Inadequate Reduction
- Injury of Pelvic Vessels by Guidewire
- Incorrect Position of the Lag Screw in the Femoral Head
- Rotation of the Femoral Head During Insertion of the Lag Screw
- Incorrect Length of the Lag Screw
- Problems During Nail Insertion
- Problems with Distal Locking
- Wound Healing Disturbances and Infection
- Mechanical Failure of Internal Fixation
- Collapse of Fragments and Medial Displacement of the Femoral Shaft
- Central Perforation of the Femoral Head by the Lag Screw
- Migration and Intrapelvic Protrusion of the Lag Screw
- Necrosis of the Femoral Neck
- Delayed Union, Nonunion, and Malunion
- Leg Length Discrepancy
- Postoperative Fracture of the Femoral Shaft
- Subcapital Fracture of the Femoral Neck
- Thigh Pain
- Abductor Pain
- Injuries to Femoral Vessels
- Avascular Necrosis of the Femoral Head
Section VI - Subtrochanteric Fractures
Chapter 13 - Subtrochanteric Fractures: Intramedullary Fixation
- History
- Classification
- Preoperative Planning and Choice of Implant
- Operative Technique
- Follow-up Care and Physical Therapy
- Common Surgical Errors
Chapter 14 - Subtrochanteric Fractures: Plate Fixation
- Epidemiologic, Anatomic, and Biomechanical Overview
- Classifications and Stability
- Therapeutic Plate Options
- Complications and Pitfalls
- Salvage Procedures
- Outlook
Section VII - Postoperative Management
Chapter 15 - Deep Vein Thrombosis and Thromboembolism: Prevention and Treatment in Hip Fracture Patients
- Incidence
- Pathogenesis
- Prophylaxis
Chapter 16 - Investigation and Management of Postoperative Delirium
- Definition
- Epidemiology
- Pathophysiology
- Diagnosis
- Risk Factors
- Prevention
- Management
Chapter 17 - Rehabilitation: Improving Outcomes for Patients Following Fractures of the Proximal Femur
- Issues in Rehabilitation Care for Patients with a Fracture of the Proximal Femur
- Reframing Rehabilitation Across the Health Care Continuum
- Principles of Optimized Rehabilitation Care
Chapter 18 - Preventing the Second Hip Fracture: Addressing Osteoporosis in Hip Fracture Patients
- Patient Profile
- Fracture Risk Assessment
- Determinants of Future Fracture Risk
- Bone Mineral Density
- Components of an Effective Osteoporosis Care Strategy
- Barriers to Osteoporosis Care
- Systems Approach to the Management of Osteoporosis
- What Is the Role of the Orthopaedic Surgeon?
Section VIII - Analysis
Chapter 19 - Best Surgical Practices
- Overview
- Optimal Surgical Tactic
- Surgical Strategies
Chapter 20 - Best Rehabilitation Practices
- Overview
- Organizing Rehabilitation Services
- Community Reintegration
- Functional Independence Measure Score
About the Author
- James P. Waddell, MD, FRCSC, Professor of Orthopaedic Surgery, University of Toronto School of Medicine, Division of Orthopaedic Surgery, St. Michaels Hospital, Toronto, Ontario, Canada.
Book Review
"Dr. Waddell has devoted a career spanning more than 35 years to the study of the best methods of treating hip fractures to improve patient outcome. His personal investigative efforts have covered the full gamut of hip fractures, including femoral neck fractures, intertrochanteric hip fractures, subtrochanteric hip fractures, and associated variants. He has personally analyzed, both in the laboratory and in the clinical setting, optimum biomechanical and clinical methods of stabilizing these fractures or treating them with arthroplasty. This career-long effort now culminates in the comprehensive book Fractures of the Proximal Femur. Dr. Waddell and his 30 authors have provided the orthopaedic community with a comprehensive treatise on the most recent advances in hip fracture epidemiology, preventative strategies, surgical techniques, osteoporosis diagnosis and treatment, and comprehensive rehabilitation strategies. The authors, who are primarily mid career, have significant clinical experience and bring an academic focus to the area. This provides readers with thoroughly researched and referenced chapters on the various types of hip fractures and their optimum treatment.
With the current North American burden of hip fracture of approximately 400,000 per year predicted to escalate to 500,000 per year by 2020, this effort is timely. This book is appropriate for trainees who are attempting to understand the basics of these principles and the experienced community surgeons who are in the trenches and managing these fractures on a daily basis. The balanced approach is to be commended because it provides the reader with a comprehensive understanding of the mechanisms of injury and the pathology of frailty, as well as optimum methods of osteoporosis diagnosis and treatment following hip fracture and ideal rehabilitative strategies. Clearly, hip fracture most often occurs in the setting of aging with diminishing strength and balance and deteriorating bone quality. It is important for the orthopaedic surgeon to focus as much on these issues as on the optimization of surgical treatment. This book is a welcome contribution to any orthopaedic library, will be widely read and cited, and will be a lasting tribute to Dr. Waddell's devotion to improving patient care for individuals with hip fracture."
-- Marc F. Swiontkowski, MD, TRIA Orthopaedic Center, Minneapolis, Minnesota
Product Details
- Hardcover: 320 pages
- Publisher: Saunders; 1 edition (2011)
- Language: English
- ISBN-10: 1437706959
- ISBN-13: 978-1437706956
- Product Dimensions: 11.1 x 8.7 x 0.8 inches
List Price: $262.00