Role of Preoperative Rehabilitation in Hip Surgeries: A Narrative Review

Hip trauma is a significant cause of morbidity and mortalityamong elderly patients. In the United States approximately30lakhs hip fractures occur each year and this number isincreasing each year along with the increased number ofelderly population. The management of hip trauma usuallydepends on the surgical management. However evidencesuggests that even with prompt surgical interventions, thepost operative complications are common and patient face agreat difficulty in post operative rehabilitation. Recently, someof the randomized trials have suggested that preoperativerehabilitation in the form of exercise or the physiotherapyis associated with improved postoperative pain score anddecreased hospital stay in elderly frail patients and in patientswith associated co morbidities such as diabetes, cardiovascular,or respiratory complications. In this present review wewill outline the importance of preoperative rehabilitationin management of different types of hip trauma based onprevious study summaries. We will also try to evaluate theimportance of such rehabilitation therapy in final outcome ofthe patients after surgery

Fractura de cuello femoral en trauma de alta energía: ¿podemos confiar en la tomografía computarizada multicorte? caso clínico / High energy femoral neck fracture: can we trust the computerized tomography scan? case report

Las fracturas asociadas de diáfisis y cuello femoral son lesiones infrecuentes. A pesar de ser una asociación conocida, es pasada por alto entre un 19-31% de las veces. A continuación presentamos un caso de una fractura de diáfisis femoral en la cual la tomografía computarizada inicial no evidenció ningún rasgo a nivel del cuello femoral; sin embargo, este rasgo se hizo presente en las imágenes de control. Existen diversos exámenes para reconocer las fracturas de cuello femoral asociadas a diáfisis femoral, como la radiografía y la tomografía computarizada. Sin embargo, a pesar de estas imágenes, pueden no ser diagnosticadas. Con este caso reafirmamos la necesidad del uso de imágenes preoperatorias e intraoperatorias en pacientes con fracturas de diáfisis femoral de alta energía y que la tomografía computarizada multicorte de ingreso puede no evidenciar fracturas mínimamente desplazadas del cuello femoral.

Simultaneous fractures of the neck and shaft of the femur are uncommon injuries. Despite it being a known combination, it is overlooked in between 19 and 31% of cases. This case report describes a femoral shaft fracture in which the initial computed tomography did not show the femoral neck fracture, although it was present in the follow-up images. There are different imaging techniques to recognise femoral neck fractures associated with femoral shaft fractures, such as radiography and computed tomography. However, despite these images, they cannot be diagnosed. This case re-affirms the need for using imaging techniques before and during the operation in patients presenting with high energy femoral shaft fractures, in order to look for an associated femoral neck fracture. Although the use of fine-cut computed tomography scan may improve the diagnostic accuracy of this test, some femoral neck fractures will still go under-diagnosed.

Chronic traumatic hip dislocation: the Cambodian experience.

Background: Evidence is conflicting on the best way to manage patients presenting late following a traumatic hip dislocation. Objective: Report our experience of managing patients presenting late following a traumatic dislocation of the hip. Patients and method: A retrospective analysis of patients presenting late with a traumatic hip dislocation to the Children’s Surgical Centre between January 2002 and September 2010 was performed. Thirty-three eligible patients were identified. Twenty-eight patients underwent femoral head conserving treatments. In four patients, total or hemi-arthroplasty was performed, and one patient underwent hip arthrodesis. Results: Eleven patients had documentation of the absence or presence of evidence of avascular necrosis (AVN). Of these, three patients had clinical or radiological signs of AVN. Nineteen patients returned for follow-up and five had an excellent outcome, seven had a good outcome, four had a fair outcome, and one had a poor outcome. Two patients did not have enough clinical information in their medical records to have their outcome classified. A better outcome at follow-up was associated with a shorter mean average time from trauma and the use of femoral head conserving operative interventions. Conclusion: This study supports the theory that patients presenting late following a traumatic hip dislocation can achieve satisfactory outcomes if managed with femoral head conserving strategies, as the femoral head retains its vascular supply in the majority of cases. We also propose that consideration be given to drilling the femoral head during open reduction to ascertain the integrity of its blood supply.