Fracture After Total Hip Replacement

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A periprosthetic hip fracture is a broken bone that occurs around the implants of a total hip replacement. It is a serious complication that most often requires surgery.

Although a fracture may occur during a hip replacement procedure, the majority of periprosthetic fractures occur after a patient has spent years functioning well with a hip replacement. Fortunately, these fractures are rare.

The treatment of these fractures is often challenging because patients are older and may have thinning bone or other medical conditions.

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Types of Shoulder Fractures

Shoulder fractures can result from a fall on the shoulder, a motor vehicle accident, contact sports, etc.

The shoulder is a complex joint connecting the arm to the body. The shoulder bones include the humerus (upper arm bone), the scapula (shoulder blade) and the clavicle (collarbone) (Figure 1). The upper end of the humerus has a ball-like shape that connects with the socket of the scapula, called the glenoid. Disruption of any of the parts of the shoulder can create difficulty with its function.

Types of Shoulder Fractures

The type of fracture varies by age. Most fractures in children occur in the clavicle bone. In adults, the most common fracture is of the top part of the humerus (proximal humerus). Some types include:

  • Clavicle Fractures: This is the most common shoulder fracture, frequently the result of a fall (Figure 2).
  • Scapula Fractures: Fractures of this bone rarely occur. They usually result from high-energy trauma such as motor vehicle accidents or a far fall.
  • Proximal Humerus Fractures: Fractures of the upper part of the arm are more common in the older (over 65 years of age) population. Sometimes, there are just cracks in the bones, but they have not moved very far out of their normal position.

Some fractures are diagnosed using x-rays. Sometimes, a CT scan is needed to see more detail.

Treatment

Treatment for these fractures can vary. Some options include:

  • Simple sling or “figure 8” strap worn for three to eight weeks, depending on the patient’s pain.
  • Surgery, which may include placing plates and screws or wires and sutures (Figure 3). This is more often needed when there is injury to the glenoid (shoulder socket) or when broken bone pieces are severely out of place.

Once healed, there may be a bump over the fracture site which may decrease with time, but sometimes a bump will remain permanently. Shoulder movement can begin as soon as pain goes away; return to sports cannot occur until full shoulder strength returns. Return to contact sports would be considered only when the fracture is fully healed as shown on an x-ray.

Selection of treatment depends upon the patient’s activity level, the location of the fracture and the severity of the fracture.

Recovery

Shoulder fractures may leave a patient with permanent shoulder stiffness, regardless of how well the bones were repaired or joint replacement performed. Recovery may require the use of physical therapy to assist in improving motion and strength. Consult your physician for the best option.


Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

Will I Need Surgery on My Broken Or Fractured Finger?

Although the bones in the hand are small, a broken (fractured) finger is not a minor injury. The bones in a normal hand line up precisely. They let you perform many specialized functions, such as grasping a pen or manipulating small objects in your palm. When you fracture a finger bone, it can cause your whole hand to be out of alignment. Without treatment, your broken finger might stay stiff and painful.

Anatomy

Your hand consists of 27 bones: eight bones in your wrist (carpals), five bones in the palm of your hand (metacarpals), and 14 bones in your fingers (phalanges). Fractures of the metacarpal bone that leads to the little finger account for about one-third of all hand fractures in adults.

Cause

Generally, a fractured finger occurs as the result of an injury to the hand. You can fracture a finger when you slam your fingers in a door, when you put out your hand to break a fall, or when your finger jams while trying to catch a ball. Carelessness when working with power saws, drills, and other tools can result in a fractured finger.

Symptoms

  • Swelling of the fracture site
  • Tenderness at the fracture site
  • Bruising at the fracture site
  • Inability to move the injured finger in completely
  • Deformity of the injured finger

Doctor Examination

If you think you fractured your finger, immediately tell your doctor exactly what happened and when it happened. Your doctor must determine not only which bone you fractured, but also how the bone broke. Bones can break in several ways: straight across the bone, in a spiral, into several pieces, or shatter completely.

Your doctor may want to see how your fingers line up when you extend your hand or make a fist. Does any finger overlap its neighbor? Does the injured finger angle in the wrong direction? Does the injured finger look too short? Your doctor may x-ray both of your hands to compare the injured finger to the uninjured finger on your other hand.

Treatment

Nonsurgical Treatment

Your doctor will put your broken bone back into place, usually without surgery. You will get a splint or cast to hold your finger straight and protect it from further injury while it heals. Sometimes your doctor may splint the fingers next to the fractured one to provide additional support. Your doctor will tell you how long to wear the splint. Usually a splint on a fractured finger is worn for about 3 weeks. You may need more x-rays over this time so that your doctor can monitor the progress of your finger as it heals.

Surgical Treatment

Depending on the type and severity of the fracture, you may need surgery to put the bones into alignment. Small devices, such as pins, screws, or wire, will be used to hold your fractured bones together.

Rehabilitation

You may begin using your hand again as soon as your doctor determines it is okay to move your finger. Doing simple rehabilitation exercises each day will help reduce the finger’s stiffness and swelling. You may be required to see a physical therapist to assist you in these exercises.


Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

Broken Arm: Signs, Symptoms, & Treatments

Description

A broken bone is commonly known as a fracture. Any bone in the arm can be broken, but common areas for fractures in the arm are:

  • Wrist, specifically the distal radius
  • Forearm bones (radius and ulna) (Figure 1A)
  • Elbow
  • Humerus
  • Shoulder

Causes

Most broken arms are caused by trauma. In younger people, common causes are falls from a height, sports injuries and motor vehicle accidents. In older people with weaker bones, a trip and fall from a standing height is a common cause of a broken arm.

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Fractures in Children: Causes, Symptoms, & Treatment

Description

Because children are still growing, their injuries need different evaluation, and sometimes different treatment.

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