Neck of femur fracture medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Created page with "__NOTOC__ {Neck of femur fracture}} {{CMG}}; {{AE}} {{Rohan}} ==Overview== There is no treatment for [disease name]; the mainstay of therapy is supportive care. OR Supporti...")
 
 
(3 intermediate revisions by one other user not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{Neck of femur fracture}}
{{Neck of femur fracture}}
 
{{CMG}}; {{AE}} {{Rohan}}
{{CMG}}; {{AE}} {{Rohan}}


==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
The mainstay of treatment for neck of femur fracture is surgery. Non-operative management is reserved for a very small proportion of patients.


OR
==Medical Therapy==
 
{| align="right"
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
|
 
[[File:Derotational boot.JPG|400px|thumb|Conservative management with derotational cast [https://upload.wikimedia.org/wikipedia/commons/2/22/Bullous_pemphgoid_in_a_72_year_old_bedridden_female3.JPG Source: Case courtesy of Ashashyou [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons]]]
OR
|}
The mainstay of treatment for neck of femur fracture is surgery. Non-operative management is reserved for a very small proportion of patients.<ref name="pmid19058696">{{cite journal| author=Faraj AA| title=Non-operative treatment of elderly patients with femoral neck fracture. | journal=Acta Orthop Belg | year= 2008 | volume= 74 | issue= 5 | pages= 627-9 | pmid=19058696 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19058696  }} </ref><ref name="pmid26263935">{{cite journal| author=Moulton LS, Green NL, Sudahar T, Makwana NK, Whittaker JP| title=Outcome after conservatively managed intracapsular fractures of the femoral neck. | journal=Ann R Coll Surg Engl | year= 2015 | volume= 97 | issue= 4 | pages= 279-82 | pmid=26263935 | doi=10.1308/003588415X14181254788809 | pmc=4473865 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26263935  }} </ref><ref name="pmid18646065">{{cite journal| author=Handoll HH, Parker MJ| title=Conservative versus operative treatment for hip fractures in adults. | journal=Cochrane Database Syst Rev | year= 2008 | volume=  | issue= 3 | pages= CD000337 | pmid=18646065 | doi=10.1002/14651858.CD000337.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18646065  }} </ref><ref>{{cite book | last = Rockwood | first = Charles | title = Rockwood and Green's fractures in adults | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia, PA | year = 2010 | isbn = 9781605476773 }}</ref><ref>{{cite book | last = Azar | first = Frederick | title = Campbell's operative orthopaedics | publisher = Elsevier | location = Philadelphia, PA | year = 2017 | isbn = 9780323374620 }}</ref>


The majority of cases of [disease name] are self-limited and require only supportive care.
===Non-operative Treatment===
 
'''Indications'''
OR
*Non-ambulators
 
*Patients with minimal [[pain]]
[Disease name] is a medical emergency and requires prompt treatment.
*Patients who are at high risk for surgical intervention
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===


* '''1 Stage 1 - Name of stage'''
'''Techniques'''
** 1.1 '''Specific Organ system involved 1'''
*Derotational [[Cast (orthopedic)|cast]]  
*** 1.1.1 '''Adult'''
*[[Traction (orthopedics)|Traction]]
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
===Complications===
** 2.1 '''Specific Organ system involved 1 '''
*[[Osteonecrosis]]
**: '''Note (1):'''
*Non union
**: '''Note (2)''':
*Complications Of Prolonged Recumbency such as:
**: '''Note (3):'''
**Hypostatic [[pneumonia]]
*** 2.1.1 '''Adult'''
**[[Pressure sores]]
**** Parenteral regimen
**[[Deep vein thrombosis|Deep venous thrombosis]]  
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
**[[Pulmonary embolism]]
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
**[[Cardiac failure]] due to weakening of the [[cardiac muscle]] and poor [[venous return]]
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**[[Muscle wasting]]   
**** Oral regimen
**Common [[peroneal nerve]] palsy
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
**Stiffening of joints
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
**[[Osteoporosis]]
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
**[[Urinary tract infections]]
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**[[Depression]]
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Latest revision as of 18:27, 29 April 2019

Neck of femur fracture Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Neck of femur fracture from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Echocardiogram

X Ray

Echocardiography and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Neck of femur fracture medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Neck of femur fracture medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Neck of femur fracture medical therapy

CDC on Neck of femur fracture medical therapy

Neck of femur fracture medical therapy in the news

Blogs on Neck of femur fracture medical therapy

Directions to Hospitals Treating Oral cancer

Risk calculators and risk factors for Neck of femur fracture medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

The mainstay of treatment for neck of femur fracture is surgery. Non-operative management is reserved for a very small proportion of patients.

Medical Therapy

Conservative management with derotational cast Source: Case courtesy of Ashashyou [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0), from Wikimedia Commons]

The mainstay of treatment for neck of femur fracture is surgery. Non-operative management is reserved for a very small proportion of patients.[1][2][3][4][5]

Non-operative Treatment

Indications

  • Non-ambulators
  • Patients with minimal pain
  • Patients who are at high risk for surgical intervention

Techniques

Complications

References

  1. ↑ Faraj AA (2008). "Non-operative treatment of elderly patients with femoral neck fracture". Acta Orthop Belg. 74 (5): 627–9. PMID 19058696.
  2. ↑ Moulton LS, Green NL, Sudahar T, Makwana NK, Whittaker JP (2015). "Outcome after conservatively managed intracapsular fractures of the femoral neck". Ann R Coll Surg Engl. 97 (4): 279–82. doi:10.1308/003588415X14181254788809. PMC 4473865. PMID 26263935.
  3. ↑ Handoll HH, Parker MJ (2008). "Conservative versus operative treatment for hip fractures in adults". Cochrane Database Syst Rev (3): CD000337. doi:10.1002/14651858.CD000337.pub2. PMID 18646065.
  4. ↑ Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.
  5. ↑ Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Neck_of_femur_fracture_medical_therapy&oldid=1565622"