# Flashcards by Zuwase Mwale

Risk factors for NOF#

Uncontrollable Risk Factors:
Being over age 50.
Being female.
Menopause.
Family history of osteoporosis.
Low body weight/being small and thin.
Broken bones or height loss.

Controllable Risk Factors:
Not getting enough calcium and vitamin D.
Not eating enough fruits and vegetables.
Getting too much protein, sodium and caffeine.
Having an inactive lifestyle.
Smoking.
Drinking too much alcohol.
Losing weight.

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Why elderly have increased fall risk

Medications
Dehydration
Cognitive impairment 
Reduced bone density
Neurovascular lesions

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2 NOF# classes/types

Intracapsular

Extracapsular

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Where do intracapsular NOF# happen

Subcapital
Transcervical
Basocervical

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2 types of extracapsular NOF#

Inter tronchanteric (greater —> lesser trochanter)

Sub trochanteric (from lesser trochanter and down 5cm)

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Which classification system is used to classify intra capsular fractures

Garden classification

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What is the Garden Classification System for intracapsular NOF#

Non-displaced incomplete #
Non displaced complete #
Partially displaced, complete #
Full displaced, complete #

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intracapsular femoral blood supply

Retrograde (distal to proximal) blood supply from medial circumflex artery

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Medial circumflex artery is branch of

Profunda femoris

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What can intracapsular NOF# lead to and how is it dealt with

Lead to AVN

Requires arthroplasty (replacement) not fixation

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Clinical features of NOF#

Pain in hip, groin or knee
Inability to weight bear
Reduced mobility or painful mobility 
Cannot perform straight leg raise
Leg shortened and externally rotated and abducted on inspection

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Where is pain on NOF#

Hip
Thigh
Groin
Knee (in elderly)

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Scans to inspect NOF#

Orthogonal view XR (AP and lateral views) of hip

Orthogonal view XR of pelvis

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Why is an AP pelvis done in suspected NOF#

To assess hip for pre-op planning and the plating
Pelvis forms hip joint
Compare “normal” unaffected hip to fractured hip

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Tests done for suspected NOF#

FBC
U+E
Coag screen
Group and save blood test

For elderly

Urine dipstick
CXR
ECG

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Initial management for NOF#

Pain relief (use pain ladder)
IV fluids (for rehydration or to maintain hydration during starving)
Thrombi prophylaxis

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Intracapsular undisplaced NOF# management

Conservative

Internal fixation

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Management for displaced intracapsular NOF #

ORIF

Arthroplasty I.e. hemiarthroplasty or total hip replacement

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Management for extracapsular NOF#

Traction
Intramedullary nail
Extramedullary nail

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Management for inter trochenteric fracture

Dynamic hip screws

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Indications for conservative management of NOF#

IMPACTION type intra-capsular undisplaced #
(RARELY DONE)

(impaction = 2 pieces of fractured bone driven into each other)

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Indications for internal fixation of NOF#

Intracapsular undisplaced

Intracapsular minimally displaced

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What is internal fixation of intracapsular NOF#

3 cannulated screws to stabilise broken bones

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Difference between hemiarthroplasty and total hip replacement

HA= only femoral head replaced with prosthesis
THR= Femoral head AND acetabulum replaced

Indications for THR

``` # in RA # 2ndary to Malignancy ```

Indications for Hemi

``` # in elderly # 2ndary to Paget's Disease / Met Bone Disease / OA ```

What is traction of a NOF#

Use tapes/ pins attached to weights to pull and decompress hip joint

What are the benefits of traction of NOF#

Relieves pain Relaxes muscles Restores mobility

Indications for intramedullary fixation

Extracapsular #

What is intramedullary fixation of NOF#

Titanium rod placed through medullary cavity of femur for stabilisation

What is the indication for extramedullary fixation of NOF#

Extracapsular #

What is extramedullary fixation of NOF#

DHS 3 parts: Large screw in neck Side plate Bicortical screws Lag screw slides through side plates

What does DHS extramedullary fixation of NOF# allow

``` #compression Primary healing Maintenance of neck/shaft angle of femur ```

Complications of NOF#

AVN | Non union

How long does the risk of AVN exist after surgery of NOF#

3 years

What is needed to monitor for AVN in NOF#

Regular scanning using MRI (MRI better than XR)

Type of fracture where non union is most common

Displaced

Risk factors for distal radius #

``` Age Female Early menopause Smoking Alcohol Prolonged steroid use ``` All related to osteoporosis

Types of distal radius #

Colles Barton’s Smith’s

Features of Colle’s #

Dorsal displacement Extra articular # (not part of articulating joint) Caused by FOOSH

Features of Smith’s

Palmar/volar displacement Extra articular # Caused by fall on back of hand

Features of Barton’s

Can be volar (more common) or dorsal displacement Intra articular # Radio-carpal joint dislocated (hallmark sign)

Clinical features of distal radius #

Pain Deformity & swelling Paraesthesia / weakness (if neurological involvement)

What should you check for on examination of suspecting distal radius #

``` Neurovascular compromise Nerve function Limb perfusion (cap refill & pulses) ```

Which nerves do you check for in neurological exam of distal radius #

Median Ulnar Radial

How do you check motor and sensory function of median nerve in distal radius #

Motor: thumb abduction (make ‘C’ shape OR thumb to little finger aka thumb opposition OR rock part of “rock paper scissors) Sensory: inside of index finger tip

How to examine Motor and sensory function of ulnar nerve

Motor: scissors with palm facing down OR thumb adduction Sensory: palm side of pinky finger tip

Examine motor and sensory function of radial nerve

Motor: paper in “rock paper scissors” (extension of IPJ of thumbs) Sensory: dorsal surface between thumb and 2nd finger

How to test motor function of anterior interosseous nerve

Make “ok” sign

Measurements that help with diagnosis of distal radius #

Radial height Radial inclination Radial tilt

Ideal radial height

Less than 11mm

Ideal radial inclination

22 degrees

what should you evaluate when deciding eligibility for surgery of distal radius #

``` Age Occupation Hand dominance Level of activity Quality of bone General medical condition ```

Treatment options for distal radius #

Non operative: Cast of Paris | Operative: Surgical reduction ORIF

Operative options for distal radius #

Manipulation under anaesthesia (MUA) and K wire Volar locking plating External fixation

Which distal radius # is MUA & K wire best fit for

2 part, non comminuted fractures comminuted= broken into more than 2 fragments

Which distal radius # is volar locking plating best

Comminuted, shortened, osteoporotic # Smith’s/ volar Barton’s #s

Which fractures is external fixation best used for

Less commonly used | Good for high energy multi-fragmentary #s

Complications of distal radius #

``` Mal/non union Ulnar nerve damage Carpel tunnel syndrome OA Compartment syndrome Infection ```