Procedurs 2

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  1. Subtrochanteric Fxs-nonunion and malunion
    • subtrochanteric region is cortical bone-decreased blood supply
    • area is prone to large stresses which can lead to loosening of fixations dedvices
  2. Fx medical management
    • ORIF
    • -nails, rods, scres, and plates
    • bed rest, traction, and protected WB
  3. THR Posterolateral Approach
    • Most common
    • integrity of vastus lateralis, gluteus med&min retained
    • highest incidence of dislocation
    • MR/ADD/FLEX will dilocate
  4. THR Lateral
    • incision into vastus lateralis, gluteus med&min
    • post-op weakenss ABD
    • trendelenburg gait
    • may involve trocahnteric osteotomy
  5. THR Anterolateral Approach
    • provides excellent hip stability
    • only used in extreme cases
    • disruption of TFL, gluteus med&min, rectus femoris, vastus lateralis, and iliopsoas
    • may require osteotomy & reattachment of great trocanter
  6. THR Comlications
    • anatalgic gait 20%
    • thromboembolus
    • loosening components 10-40%
    • post op dislocations 1-4%
  7. THR ROM Precautions
    • ADD past midline
    • IR past neutral
    • FLEX past 80 degrees
  8. THR ADL Precautions
    • Transfer to sound side
    • do not cross legs
    • dont sit in low chiar
    • acoid bending trunk when moving
    • pivot on sound LE
    • sleep supine with ABD pillow
  9. THR ROM Precautions
    Anterolateral & lateral
    • Extension, Add, & ER past neutral
    • Combined hip Flex, Abd, & ER
    • no actice anit gravity ABD 6-8 wks for glut med reattached or trocahnteric osteotomy
  10. ADL Precautions
    Anterolaterl & lateral
    • step to
    • same as Posterolateral ADL pres except avoid standing and rotating away from opertated LE

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Procedurs 2
2012-10-05 22:41:19

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