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Orthopaedics
Hip
Built from Orthopedic Trauma Essentials
What’s inside
6 sections · 112 slides
Overview
- Four injuries, one region
- Parts of the upper femur
- The socket side
Hip Dislocation
The ball leaves the socket, and the clock starts running
- When the ball leaves the socket
- Putting it back, then proving it is back
- Why the clock matters
- What avascular necrosis means
- Dead bone in the femoral head
- How fast must the hip go back?
- Hougaard: 100 posterior dislocations
- Dreinhofer: everyone reduced inside 6 hours
- Ahmed: pooling five studies
- 4.8%
- Verdict: reduce within 6 hours
- When can the patient walk again?
- Three protocols, three answers
- What Schlickewei actually compared
- Verdict: move early, load slowly
- Should everyone get a hip arthroscopy?
- What the camera finds that scans miss
- When symptoms will not settle
- Verdict: targeted, not routine
Femoral Head Fractures
When a piece of the ball itself splits away
- A piece of the ball breaks off
- The pit on the femoral head
- The Pipkin classification
- Reading the four Pipkin types
- A broken socket wall
- Fix it, or replace it straight away?
- Wang: Pipkin III fixed in young patients
- Scolaro and Cichos: the failure rate
- Why a rescue replacement is worse
- Verdict: replace early in selected patients
- What to do with a Pipkin I fragment?
- Chen: the one randomised trial
- Tsai: pooling everything available
- Holmes: how much can safely go
- Verdict on Pipkin I
- Which way into the hip?
- Three head-to-head comparisons
- Verdict on the approach
Femoral Neck Fractures
The classic broken hip: fix it, replace it, and how fast
- The classic broken hip
- Can you see the break?
- Now with the fracture marked
- How soon should an elderly hip be fixed?
- The case for operating early
- The case against racing the clock
- From arrival to theatre
- Verdict: operate within 24 to 48 hours
- Half a hip, or a whole hip?
- A total hip replacement in place
- Lewis and Li: what the pooled data show
- Migliorini and HEALTH
- Hemiarthroplasty against total hip
- The drawback of a total hip
- Verdict: offer both, decide together
- Should the stem be cemented?
- What the cement trials found
- Verdict: cement it
- Does a young patient need surgery tonight?
- Timing in the young: four studies
- Verdict: early, but reduction matters more
- Open the hip, or reduce it closed?
- Open against closed: the evidence
- Verdict: chase the reduction, not the route
- Which implant holds a neck fracture?
- Ways to hold a femoral neck fracture
- How a sliding hip screw works
- FAITH: the big randomised trial
- Where the two implants part ways
- Does an antirotation screw help?
- Getting cancellous screws right
- The femoral neck system compared
- Verdict on the fixation construct
Peritrochanteric Fractures
Breaks through the bony bumps, and the metal that holds them
- Breaks through the bony bumps
- A break across the top of the femur
- What a cephalomedullary nail is
- How should the broken edges sit?
- Three ways the cortices can sit
- What the AMCS studies show
- AMCS in real patients
- Verdict on cortical support
- Helical blade, or lag screw?
- Blade against screw: the evidence
- Okike: ten years of follow-up
- Verdict: either is fine
- Short nail, or long nail?
- A femoral shaft break fixed with a long nail
- How a long nail sits inside the bone
- Short against long: the evidence
- Shannon: the randomised answer
- Verdict on nail length
- Should the implant be cemented in?
- Cement: the cohort studies
- Cement: the randomised trial
- Dall'Oca, and the verdict on cement
What to Remember
The four verdicts, and where the evidence still runs out
- Take-home: hip dislocation
- Take-home: femoral head fractures
- Take-home: femoral neck fractures
- Take-home: peritrochanteric fractures
- How strong is the evidence?
- Where the evidence still runs out
- References
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- Orthopedic Trauma Essentials 2026