.... Flashcards
What are the common causes of pelvic fractures?
High energy injuries in the young (e.g., RTA or fall from height) and frailty fractures of older osteoporotic bone.
What typically happens in bony ring disruption in pelvic fractures?
Bony ring disruption usually affects more than one site, often multiple bones or symphysis/SI joints, more likely in high-energy injuries.
What classification system is used for pelvic ring fractures?
The Young-Burgess classification is used to classify pelvic ring fractures.
What are the primary clinical features of pelvic fractures?
The primary clinical features include pain and the inability to bear weight.
How are pelvic fractures investigated in high-energy injuries?
If the pelvis is the only site of injury, an x-ray is conducted first. In polytraumatic patients, a CT scan is the primary investigation. CT can also provide details of fractures shown by x-ray.
What investigation methods are used for low-energy pelvic fractures?
Low-energy fractures are often undisplaced and might not show on x-rays. CT is more sensitive than x-ray, especially as fractures start to heal. MRI is the most sensitive and the test of choice.
What is the initial management for high-energy mechanisms in pelvic fractures?
The initial management involves using a pelvic binder, which helps control circulatory loss.
What are the conservative management options for pelvic fractures?
Conservative management includes analgesia and weight-bearing as tolerated.
What are the operative methods for managing pelvic fractures?
Operative approaches include ORIF (Open Reduction and Internal Fixation), external fixators, and internal fixators.
What are the typical mechanisms of injury for pelvic fractures based on age groups?
In the elderly, pelvic fractures typically result from a low-impact fall, while in young adults, they are caused by high-energy trauma.
What are some associated factors with pelvic fractures in the elderly population?
Osteoporosis is a significant factor, with 73% of affected patients being female. Additionally, low-impact falls are the common cause, and 92% of patients are over 60 years old.
What are the risk factors associated with pelvic fractures?
Risk factors include osteoporosis, smoking, alcohol use, malnutrition, neurological impairment, impaired vision, and low BMI.
How are intracapsular fractures classified and what complications are associated with them?
Intracapsular fractures occur proximal to the intertrochanteric line, involve the femoral head and neck, and can be subcategorized as subcapital and transcervical fractures. These fractures may lead to femoral head AVN (avascular necrosis) and non-union. The Garden classification is used to predict union and the risk of AVN, influencing treatment decisions.
What characterizes extracapsular fractures and their associated risks?
Extracapsular fractures occur distal to the intertrochanteric line and are subcategorized into basicervical, intertrochanteric, reverse oblique, and subtrochanteric fractures. They generally maintain blood supply to the head of the femur, making AVN and non-union rare.
What clinical symptoms are associated with pelvic fractures?
Symptoms include hip/groin pain, possible swelling, and the inability to bear weight.
What signs might indicate a pelvic fracture upon examination?
Signs include a shortened and externally rotated lower limb on the affected side, neurological and vascular status assessment of the lower limb, assessment for cognitive impairment, scrutiny for missed injuries, and evaluation for dehydration in cases where patients may have been immobile for an extended period.
What is the mortality rate at one year for pelvic fractures?
The mortality rate at one year is reported to be around 30%.
What imaging methods are commonly used for diagnosing pelvic fractures?
X-ray and MRI are frequently employed. X-rays can detect most fractures, particularly in the pelvis and lateral hip. Loss of contour of Shenton’s line in a pelvic x-ray can indicate a hip fracture, but fractures to the femoral neck may not always cause this loss. MRI is used when fractures are subtle or not visible on x-ray, especially in cases where clinical suspicion persists.
How is the management typically approached for pelvic fractures?
Usually, management involves an operation followed by early mobilization to prevent complications from prolonged bed rest. Additionally, local nerve blocks are preferred over strong opiates for analgesia.
What role does surgical management play in treating pelvic fractures?
Surgical management is often involved, aiming to stabilize the fractures and enable early mobilization.
Besides X-ray and MRI, what other investigations might be considered for pelvic fractures?
Other investigations such as ECG and blood tests are sometimes conducted in the management of pelvic fractures.
What is the approximate 30-day mortality rate for hip fractures?
The 30-day mortality rate for hip fractures typically ranges from 5-10%.
What are the major risk factors associated with hip fractures?
Increasing age and osteoporosis are major risk factors for hip fractures. Additionally, females are more frequently affected than males.
What is the usual timeframe for performing surgery for hip fractures?
Surgery for hip fractures is generally aimed to be performed within 48 hours to decrease associated morbidity and mortality.
What specialty focuses on optimizing the medical complications of inpatients, particularly the elderly with hip fractures?
Orthogeriatrics is the specialty that focuses on identifying and optimizing the medical co-morbidities and complications of inpatients on orthopaedic wards, particularly in elderly patients with hip fractures.
How are hip fractures categorized?
Hip fractures are categorized into intra-capsular fractures and extra-capsular fractures.
What structures constitute the top of the femur?
The top of the femur consists of the head, neck, greater trochanter (lateral), lesser trochanter (medial), intertrochanteric line, and shaft (body).
What structures does the hip joint capsule attach to?
The hip joint capsule attaches to the rim of the acetabulum on the pelvis and the intertrochanteric line on the femur, surrounding the neck and head of the femur.
What is the significance of the blood supply to the femoral head in intra-capsular fractures?
In intra-capsular fractures, disruption of the blood supply to the femoral head can lead to avascular necrosis. Depending on the displacement of the fracture, different surgical interventions such as internal fixation for non-displaced fractures or hemiarthroplasty/total hip replacement for displaced fractures are considered to preserve or replace the femoral head.
What does the Garden classification indicate in intra-capsular neck of femur fractures?
The Garden classification differentiates intra-capsular fractures based on their severity: Grade I (incomplete and non-displaced), Grade II (complete and non-displaced), Grade III (partially displaced), and Grade IV (fully displaced).
What are the differences between hemiarthroplasty and total hip replacement for treating displaced intra-capsular fractures?
Hemiarthroplasty involves replacing the head of the femur while leaving the acetabulum intact, often for patients with limited mobility or significant co-morbidities. Total hip replacement replaces both the head of the femur and the socket and is generally offered to patients who can walk independently and are fit for surgery.
How are extra-capsular fractures distinguished in terms of the femoral head’s blood supply and their treatment approach?
Extra-capsular fractures do not disrupt the blood supply to the femoral head. As a result, the femoral head does not require replacement. Intertrochanteric fractures between the greater and lesser trochanter can be treated with a dynamic hip screw. Subtrochanteric fractures, occurring distal to the lesser trochanter, are managed using an intramedullary nail.
What are the typical symptoms and presentation of a patient with a hip fracture?
The typical presentation includes an older patient (usually over 60) who has fallen, presenting with pain in the groin or hip, which may radiate to the knee. They are unable to bear weight, and their leg might appear
shortened, abducted, and externally rotated.
Why is it crucial to assess acute illnesses in a patient with a new hip fracture?
Assessing acute illnesses is vital as there is often an underlying reason for the hip fracture, such as anaemia, electrolyte imbalances, arrhythmias, heart failure, myocardial infarction, stroke, or infections (urinary or chest). Identifying these conditions early is essential to optimize the patient for surgery and minimize delays.
What is the significance of exploring the circumstances surrounding a “mechanical fall” in a patient with a hip fracture?
Exploring the details of a “mechanical fall” is crucial because while it might suggest a simple cause for the fall, such as tripping over an object or being knocked over, a more comprehensive investigation may reveal an underlying and correctable medical cause such as anaemia, arrhythmias, or social contributors like dehydration, incorrect eyewear, poor footwear, or obstacles at home. Addressing these factors can significantly impact the patient’s well-being and impress orthogeriatric colleagues.
What imaging methods are typically used for diagnosing hip fractures?
X-rays, particularly anterior-to-posterior (AP) and lateral views, are the initial choice for diagnosis. What is Shenton’s line, and why is it important in hip X-rays?
When might MRI or CT scans be used in diagnosing hip fractures?
MRI or CT scans may be utilized when x-rays do not show a fracture but one is still suspected.
What initial management steps are typically taken upon admission for a patient with a hip fracture?
Upon admission, patients with a hip fracture are typically provided with appropriate analgesia, undergo diagnostic investigations such as x-rays, are assessed for venous thromboembolism risk, receive prophylaxis (e.g., low molecular weight heparin), have pre-operative assessments including blood tests and an ECG to ensure fitness for surgery, and receive input from orthogeriatrics.
According to NICE guidelines, when should surgery be performed for a patient admitted with a hip fracture?
As per NICE guidelines (updated 2017), surgery for a hip fracture should be performed either the same day or the day following admission, within a 48-hour timeframe.
Why is it important for patients to weight bear immediately after the operation for a hip fracture?
Allowing immediate weight bearing after the operation facilitates early mobilization and rehabilitation by physiotherapists, aiding in a quicker post-operative recovery. Additionally, post-operative analgesia is crucial to encourage early mobilization.
What defines a Lisfranc injury in terms of the affected anatomical structures?
A Lisfranc injury involves a traumatic disruption between the articulation of the medial cuneiform and the base of the second metatarsal.
