Tratamiento de las Fracturas de Cadera

Tratamiento de las Fracturas de CaderaDr. Gregory Alan Levy HoldenResidente de Traumatologa y OrtopediaGeneralidadesLa impotencia funcional por dolor Acortamiento y rotaciones de la extremidad

FRACTURA DE CADERA

GeneralidadesLa mayor parte de las fracturas de cadera requerirn una reparacin quirrgica

Retraso >48 hrs aumento la mortalidad al mes y al ao (1,2)

En UrgenciasUrgenciasTratamiento preoperatorioTerapia analgsicaProfilaxis gastroprotectoraTrombo profilaxisMedias TEDDrogas antitromboticasMedidas GeneralesMedidas para prevenir lceras por decbitoInspirmetro incentivoMarco ortopdicoTRACCION? (Finsen y cols, Needoff y cols, Jerre y cols)SUSPENDER:Benzodiacepinas, anticolinrgicos, antihistamnicosSi no se utilizas medidas TVP 50% y TEP 7.5% (cuarto causa de muerte en estos pacientes)7Tratamiento ConservadorSolo en pacientes cuya esperanza de vida es corta, no existe beneficio en realizar la cirugaPacientes que presentan datos de consolidacinPaciente rechaza tratamiento

QuirrgicoDepende de la localizacin de la fracturaClasificacionesLocalizacin Anatmica (clasificacin de Delbert)Subcapitales (Intracapsular)Transvervical (Intrcapsular)Basicervical (Intracapsular)IntertrocantericasTranstrocantericasSubtrocantericas

Tratamiento de las Fracturas IntracapsularesOsteosntesisTornillos canulados Pacientes jvenes < 60 aosPoco o ningn desplazamiento

Sistemas tornillos deslizantes (DHS o PCCP)Fracturas Basicervicales

Complicaciones:Pseudoartrosis (20-33%)Necrosis cabeza femoral (10-20%)Necesidad de reintervencin (20-36%)

Tratamiento de las Fracturas IntracapsularesArtroplastasFracturas DesplazadasPacientes mayores y con pocos requerimientos mecnicosRetraso en la intervencin >5 diasConminucin cuello femoralFracturas en terreno patolgicoAlteraciones previas de la articulacin coxo-femoralCoxartrosisReumatismos Inflamatorios

Tratamiento de las fracturas Extra capsulares Dispositivos Extra medularesDHSPCCP

Dispositivos IntramedularesClavo centro medularesGamma, PFN, Targon, etc.

Cuidados Post operatorios inmediatosOxgeno suplementarios las primeras 48-72 hrsControl de lquidos estrictoSonda de FoleyAnalgesia Trombo profilaxis en las primeras 12 hrs de pos operadoProblemas frecuentesComplicaciones pulmonaresNeumona post operatoriaAtelectasiasSndrome de distress agudo respiratorio (SDRA)Embolismo grasoTriada: Insuficiencia respiratoria, Rash petequial y dao neurolgicoComplicaciones frecuentesCardiovascularesInfarto agudo al miocardio (mortalidad 70%)Insuficiencia cardiaca congestivaArritmias Cardiacas

Reposicin de la prdida sangunea< 8 g/dl de HB indicacin de transfusin8-10 g/dl solo en pacientes (cardiopata isqumica, ateroesclerosis avanzada)La meta en niveles de >10g/dl

Medidas al da siguientes de la intervencinSolicitar laboratoriosBiometra hemtica

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