Cadera
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FRACTURAS INTERTROCANTERICAS
DR ANGEL CABEZAS ROMAN
POSTGRADO DE ORTOPEDIA Y TRAUMATOLOGIA
HOSPITAL ENRIQUE GARCES
UNIVERSIDAD CENTRAL ECUADOR
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sterry Canale, Beaty J. Campbell cirugia ortopedica 2010
EPIDEMIOLOGIA
50% de fracturas de femur proximal
Incidencia: 66-76 años
200000 casos/año USA, 63 y 34/ 100000 población por año en pactes femeninos y masculinos.
2:1 a 8:1 mujeres – hombres.
Representan 30% de pacte hospitalizados USA
Mortalidad 15-30%
Gasto estimado 10000 millones de dólares al año
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ANATOMIA
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Anatomía de la Cabeza Femoral Humana: Consideraciones en Ortopedia, Parte II. Biomecánica y Morfología Microscópica. Raúl Álvarez San Martín. José Antonio Velutini Kochen. Int. J. Morphol., 29(2):371-376, 2011.
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MECANISMO
ALTA ENERGIA
BAJA ANERGIA
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EVALUACION CLINICA
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EVALUACION RADIOGRAFICA
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CLASIFICACION1949 (Boyd y
Griffin)
1949 (Evans)
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TRATAMIENTO
NO QUIRURGICO
PACIENTES CON RIESGO MEDICOS ALTOS
DEMENCIAS NO AMBULATORIO
NO DESPLAZADAS
RIESGOS: EMBOLISMO PULMONAR, ATELECTASIAS, ESTASIS VENOSAS, ULCERAS PRESION.
MORTALIDAD 34.6% (HOROWITZ- TRACCION)
QUIRURGICO: FIJACION INTERNA MOVILIZACION PRECOZ CARGA COMPLETA
ESTABILIDAD (MATTHEWS Y SONSTEGARD): CALIDAD OSEA PATRON FRACTURA REDUCCION DISENO IMPLANTE COLOCACION
IMPLANTE
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FACTORES PREDICTIVOS POSITIVOS DE INDEPENDENCIA (KOVAL 1996)
Edad menor a 85 años
Tres o menos patologias asociadas
Independencia previa a la fractura
Deambulacion con fisioterapia en el momento del alta.
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IMPLANTESSISTEMA DHS (DYNAMIC HIP SCREW)
Tornillo deslizante- placa lateral.
Colocación a 1cm de hueso subcondral.
Posición central en cabeza femoral (Tip-apex distance: Baumgaertner).
< 25 mm: < riesgo cut out.
4-12% pérdida de fijacion.
(patrón de fractura-inestable)
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INTRAMEDULAR HIP SCREW NAIL
GAMMA/PFN/TFN
Exposición limitado o cerrado.
Menor sangrado
Menor daño tisular
Limita colapso fractura
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GAMMA - PROTESIS
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Tratamiento de fracturas de extremidad superior de femur: clavo Gamma. Lucas Cardenas. Osteosintesis. Masson III
1980
ESCUELA DE ESTRABURGO
FIJACION RIGIDA
TROCANTERICO Y CLAVO LARGO
EFECTO DE PUNTA: ESTRESS EN PUNTA DE CLAVO: FX FEMUR DISTAL. TAMANO Y DISENO
IMPLANTE EXCESIVO FRESADO FENOMENO DE CORTE
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PFN
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TFN
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COMPLICACIONES
PERDIDA DE FIJACION 20%
NO UNION 2%
DEFORMIDAD, MAL ROTACION
OSTEONECROSIS CABEZA FEMORAL
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GRACIAS