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The Surgical Technologist
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JANUARY 2015
16
Advances made in the 18th century, such as John Hunt-
er’s research on tendon healing and Percival Pott’s work on
spinal deformity steadily increased the range of new meth-
ods available for treatment. Antonius Mathysen, a Dutch
military surgeon, invented the plaster of Paris cast in 1851,
and in some cases, this method is still in use today.
Hugh Owen Thomas, a Welsh surgeon, became inter-
ested in orthopedics and bone setting at a young age and,
after establishing his own practice, went on to expand the
field into general treatment of fractures and other mus-
culoskeletal problems. Dr Thomas pioneered many tech-
niques and instruments used to detect defects and heal
bone breaks and deformities. He invented the device
known as an osteoclast, used to break and reset bones.
Gerhard Küntscher from Germany pioneered the use
of intramedullary rods to treat femur and tibia fractures.
This made a noticeable difference in the speed of recovery
of injured German soldiers during World War II. It also
led to a widespread adoption of intramedullary fixation of
fractures throughout the rest of the world. In the 1970s,
Harborview Medical Center in Seattle popularized intra-
medullary fixation without opening up the fracture.
1
A N A T O M Y O F T H E H I P
The hip anatomy consists of the acetabulum, femoral head,
femoral neck, greater and lesser trochanter, the proximal
femoral shaft and the medial femoral shaft. For the pur-
poses of this article, the focus will be on the trochanteric
part of the hip anatomy, the femoral head and the proxi-
mal femur. The intertrochanteric regions are made up of
the proximal femur distal to the neck extending to the
lesser trochanter. The majority of the bone in this region
is cancellous, extracapular and highly vascularized leading
to a robust healing environment.
2
P A T I E N T D E M O G R A P H I C S
The typical hip fracture patient is female, in her 60s to 70s,
usually showing signs of osteoporosis, has a history of falls,
may use a cane or other walking aid, presents pain in the
hip and has an inability to put weight on the affected leg.
Often, patients describe the incident as a “pop and then fall.”
Patients often will describe minor hip pain prior to the fall
or a sudden onset of major hip pain. This is characteristic of
a pathological fracture due to the development of osteopo-
rosis. Although the trochanteric region is not often affected
by trauma, emergency departments do see patients outside
of this typical demographic with trochanteric hip fractures
due to trauma. The neck of the femur is usually affected by
trauma and the trochanter is affected by pathological disease
such as cancer or osteoporosis. Drawing blood for lab work
and checking the metabolic bone panel including calcium,
phosphorus, Vitamin D3 and albumin is recommended. Any
values found to be insuffucient should be corrected in order
to maximize a patient’s outcome.
Atypical demographics also can occur. Intertrochanter-
ic fractures are rare in younger patients and need further
investigation. In this demographic, intertrochanteric frac-
tures can be the result of a high-energy impact trauma or
pathological conditions such as cancer. Patients that have
had a previous humurus fracture are at a five times greater
risk of a femoral fracture within a year and are at a three
times greater risk of a subsequent hip fracture. A third of
elderly males that suffer hip fractures die within the first
year. Hip fracture patients with liver disease, renal failure
and/or metastatic cancer have a particularly high mortal-
ity rate. Patients should consider a hip dual-energy X-ray
absorptiometry (DEXA) to assess osteoprosis and fall risks.
Patients who realize their risks for falls are more likely to
reduce the risks and hazards and, ultimately, the costs asso-
ciated with falls and hip fractures.
3,4
S U R G I C A L O P T I O N S
While non-surgical options are rare, some patients may
present with too many comorbidities for immediate surgery.
Most patients with hip fractures present to the emergency
department as the result of a fall or accident. Occasionally,
elderly patients living alone may fall and not be found for
hours or even days. This also could lead to dehydration
causing their blood glucose and electrolytes to become off
Many developments in orthopedic surgery result-
ed from experiences during wartime. In the Mid-
dle Ages, the injured were treated with bandages
soaked in horse blood, that would later dry to forma
stiff split. Theunsanitary splint was discontinuedas
orthopedic and aseptic practices developed tomore
modern standards.
