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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
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Fx medical management
- ORIF
- -nails, rods, scres, and plates
- bed rest, traction, and protected WB
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THR Posterolateral Approach
- Most common
- integrity of vastus lateralis, gluteus med&min retained
- highest incidence of dislocation
- MR/ADD/FLEX will dilocate
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THR Lateral
- incision into vastus lateralis, gluteus med&min
- post-op weakenss ABD
- trendelenburg gait
- may involve trocahnteric osteotomy
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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
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THR Comlications
- anatalgic gait 20%
- thromboembolus
- loosening components 10-40%
- post op dislocations 1-4%
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THR ROM Precautions
Posterolateral
- ADD past midline
- IR past neutral
- FLEX past 80 degrees
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THR ADL Precautions
Posterolateral
- 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
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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
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ADL Precautions
Anterolaterl & lateral
- step to
- same as Posterolateral ADL pres except avoid standing and rotating away from opertated LE
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