Service Orthopaedics Women's HSM Fractures of the upper end of femur Trochanteric fractures of the neck of Femur Fractures

Patients Admitted in the Departments of Orthopaedics, HSM. Sex Male Female Total No. of patients 535 678 1213 % Of% of patients in the patients in Services Services Orthopedics Orthopedics H SM HSM 56% 56% 44% Male Female % Of inpatients second pathology % Of patients admitted at the second age bracket Orthopaedics Women [65-75 [; August 1% [45-65 [; 26% > = 75; 37% <1; 0% [5-1 [, 0 [25-45 [; 0% [1-1 [, 05 [1-5 [; 1 2% [1-25 [; 5 5% 1, 5% 0.5% Hip joint Ilion Greater trochanter of the femur head Colo Small trochanter intertrochanteric lin e Body of femur

• Muscles Muscles of the hip joint Short adductor / gracilis / pectineus Adductor longus Adductor magnus Gluteus maximus Gluteus medius Glute minimum Piriformis / square femoral / obturator internus External shutter Iliopsoas Recto femoral Sartorius and tensor fascia lata Vastus lateralis Semimembranosus Semitendinosus Biceps femoris long Ligaments of the hip joint Denervation of the hip joint Vascularization of the hip joint Vascularization of the hip joint Vases Ramos round ligament capsular arteries nourishing internal Fractures of the upper end of the femur Intracapsular Extracapsular 1 February 3 "The patient, usually an elderly woman, slipped and fell, no longer able to stan d up without assistance and unable to rely on the traumatized limb ..." The pati ent can place his feet after the fall, possibly walk a short distance ... "(impa cted). SERRA, 1996 Fracture femoral neck

Rare in young individuals and in patients without osteoporosis, pathologic fract ures, risk of vascular injury affecting the movement of the proximal fragment; m ainly affects the elderly in low-intensity trauma due to a fall. Fracture femoral neck Signs of fracture In a few fragments are strongly impacted, with little abduction of the distal fr agment on the proximal. Pain in inguinal area External rotation of the State in which the knee and foot pointing sideways due to rotation of 90 °. Shortening 23 cm; Impotence functional; Fracture femoral neck Fracture femoral neck Treatment Arthroplasty. Fixation with screws and plate Fracture femoral neck Most frequent complications Avascular necrosis; Lack of consolidation; late arthrosis. "After the fall the patient is unable to stand up alone and can not unload weigh t on the affected member ..." SERRA, 1996 Trochanteric fracture Frequent in the elderly, especially in females. Often appear between 75 and 85 years of age and the cause is almost always a fal l. Trochanteric fracture Signs of fracture Shortening and external rotation; Pain is more intense on the trochanter; After one or two days a bruise appears on the back of the upper thigh; Trochanteric fracture Trochanteric fracture Treatment Internal fixation with a nail plate. Conservative Trochanteric fracture Most frequent complications Few complications Malunion;

Limb shortening rarely exceeds 2-3 cm. but Nursing Care and Rehabilitation Care Nurse. preoperative general • Psychological preparation: • explanation of all procedures to patient; • keep the patient calm and provide all information about your health; • Provide information about the type of surgery and anesthesia; • Teaching about placements allowed postoperatively as well as rehabilitation and strengthening exercises and respiratory muscle; • Care Nurse. preoperative general Physical preparation: • Fasting (8 hours) before surgery; • Trichotomy lower; th e whole member • Remove rings, prostheses ... # In the femoral neck Aebi, and Gloor KOCK (1997) considered important in pre-op erative: Education about: • placements permitted and prohibited; • Technical lateralizati on in bed; • Early mobilization in bed; • Technical input and output of the bed; • Transfer Mode bed-chair-toilet and bath; It is important to: • Monitoring for signs • Review vital process of the patient Care Nurse. Postoperative Careful observation of nurses, due to risks of surgical procedure as well as hip arthroplasty: • Hematoma: • Deep vein thrombosis • Pulmonary embolism: fat embolism •: • Infec tion: • Reaction to acrylic cement: • Dislocation of the prosthesis: • Implant p lacement or inadequate Care Nurse. Postoperative • Maintenance of the vital respiratory and circulatory functions; • Muscle tonin g; • Restoration of joint mobility; • Surveillance of the dressing and wound; • Surveillance of drains; Care Nurse. Postoperative • Assessment of neurovascular extremity operated; • Cryotherapy; • Maintenance o f fluid and electrolyte balance; • Maintenance of appropriate placements; Care Nurse. Postoperative • Assessment of level of consciousness. • Maintenance of an adequate blood volum e to prevent the installation of a framework for hypotension. • Avoid sitting fo r 70-10 days, depending on the surgeon's opinion. • The patient should keep the legs elevated and abducted XHARDEZ (1990) and PETITDANT and GOUILLY (1992) Consider surgical 3 pathways of

approach - Anterior or antero-external - to avoid extension, abduction and external rotat ion; - via post or Moore - avoid flexion, adduction and internal rotation - late ral approach - avoiding adduction and external rotation. It is essential: • Asse ssment of neurovascular end operated Caneira (1998) finds that: Raise the bed (5 days) taking into account: • The alternating supine to lateral • The output of the bed • The gait training to three points should start around the 2nd day SERRA, 1996 • Patients with trochanteric fracture after surgery can stay in bed freely witho ut restrictions of movement, is encouraging the active exercises of the hip and knee from the beginning. • You can start walking with crutches in the 1st and 2n d day after surgery and this is especially important in the elderly since they b arely tolerate immobility. Preparation for high • Teachings • Prepare a letter of discharge; • Provide a leaflet; behaviors to b e adopted are primarily determined by rules of hygiene in order to save the life of your new joint and the prevention of movements luxantes. PATTERN LEMOS and PROENÇA (1998): • Avoid activities that carry hip, weights or run overwhelm • Use Canadian (3 months) and walking to 3 points (1 month) • Avoid brisk, long walks, standing and prolonged sitting position; Also according PATTERN LEMOS and PROENÇA (1998): • Do not cross your legs or flex the thigh in addition to 90; • Avoid internal a nd external rotation; • Avoid high heels; • Use chairs sit high, device for lift ing of the toilet seat and grab bars in shower and next to WC; Godart (1990) Avoid IM injections in the region nadegueira - infections. PETITDANT and GOUILLY (1992) • Use assistive devices for dressing; • Taking a bath with shower, • sexual activity is permitted; • flex the knee on a chair so you can put your socks behind; • Use long-handled shoehorn In the opinion of Caneira (1998) • Sleep with a pillow abduction (8-12 months) • Sit in chairs with arms for supp ort; • Do not bend your body over the legs from the sitting position; • The shif ts in the bed should be made of so as to avoid twisting the trunk on the pelvis; Aebi-MULLER, and GLOOR.MORICONI KOCK (1997) • The patient should immediately con tact the health care team if you have any pain; • Use elastic stockings, not gai ning weight, keep the muscle-building exercises • The patient should notify the dentist who has a prosthetic • During the 1st month you can soak up the side are , with a large cushion between your knees. After 3 months you can lie on the ope rated side;

PETITDANT and GOUILLY (1992). • The driving can be started at 3 months. Aebi, Gloor E KOCK (1997) • The patient between the two to three months is just a passenger; To enter the car sits and a movement block rotates the legs inward. To exit does the opposite; PETITDANT and GOUILLY (1992) and AEBIMULLER, and GLOOR.MORICONI KOCK (1997) Are the consensus that: • Swimming, gymnastics and walking selective avoiding un even ground are indicated • The tennis and riding are contraindicated. • The pat ient should be taught about the correct way up and down stairs Climbing, 1st pla ce on the rung above the foot are and then the Canadian and foot patient; When d escending, 1st place on the step below the Canadian, followed by if the foot and then the patient is standing. In relation to trochanteric fracture: Since consolidation is faster, the period of hospitalization in general less; Pr eparation for the high does not include many teachings and for the hip prosthesi s: strengthening exercises for muscle toning. and Education should also focus on prevention of falls: • use rubber shoes, with soles • Finding strategies to eliminate architectural barriers; • using artificial eye s, hearing or • use of gait aids; • perform moderate exercise; • use of hip protectors; All this because: The most deadly injury to a human limb can suffer at any age is the fracture of the upper extremity of the femur, particularly the neck, whose mortality and mor bidity increases with age and its associated diseases, making it the most common cause of traumatic death after 75 years " R. Tronzo, 1973 Thank you for your attention ... Work done by: Fábio Gonçalves