[1] Hip Fractures Flashcards
What is a hip fracture?
A fracture of the proximal femur
What is considered to be the proximal femur?
5cm or less below the lesser trochanter
Why are hip fractures important in the NHS?
They are the most common reason for admission onto an orthopedic trauma ward
What are the types of hip fracture?
- Intracapsular fracture
- Extracapsular trochanteric fracture
- Extracapsular subtrochanteric fracture
What does an intracapsular fracture involve?
The femoral neck between the edge of femoral head and the insertion of the capsule of the hip joint
Where does the break occur in an intracapsular fracture?
Below the ball, or in the neck of femur
What complication can arise from intracapsular fractures?
They can disrupt the blood supply to the femoral head, leading to avascular necrosis
What proportion of all hip fractures are intracapsular?
Around half
What is an extracapsular trochanteric fracture?
A fracture that is distal to the insertion of the capsule, involving or between trochanters
What is an extracapsular subtrochanteric fracture?
Fractures below, but no more than 5cm below, the lesser trochanter
What does an extracapsular subtrochanteric fracture involve?
The proximal femoral shaft at, or just distal to, the trochanters
What are the risk factors for hip fractures?
- Increasing age
- Osteoporosis
- Osteomalacia
- Falls
What factors might falls be secondary to?
- Lack of core strength
- Instability
- Gait disturbance
- Sensory impairment
In who can hip fractures follow a relatively minor trauma?
- Elderly
- Those with osteoporosis
- Those with metastatic disease
What causes hip fractures in younger patients?
Usually caused by high energy trauma
What are hip fractures in younger patients often associated with?
Other serious injuries
How do hip fractures present?
- Pain
- Inability to weight bear
- Affected leg may be shorted, adducted, and externally rotated
What are the features of the pain in hip fractures?
It is typically in the upper outer thigh or in the groin, and may radiate to the knee
It may be aggravated by flexion and rotation of the leg
How are hip fractures investigated?
- Imaging
- General workup
- Early assessment for cognitive impairment and treatable conditions
What is involved in a general workup in hip fracture?
- FBC
- Crossmatch
- Renal function
- Glucose
- ECG
What treatable conditions may be involved in the aetiology of a hip fracture?
- Anaemia
- Volume depletion
- Electrolyte imbalance
- Acute confusional state
- Uncontrolled diabetes
- Uncontrolled heart failure
- Chest infection
What imaging is done in hip fractures?
- X-rays
- MRI
What kind of x-rays are done to investigate a hip fracture?
AP pelvic and lateral x-rays
What may the x-ray show in hip fractures?
- Disruption of trabeculae and inferior or superior cortices
