[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
What is Shenton’s line?
A radiographic, curved line formed by the top of the obturator foramen and the inner side of the neck of the femur.
It is broken in fractures
What is Shenton’s line used to determine?
The relationship between the head of the femur and the acetabulum
When should MRI be performed in hip fractures?
If hip fracture is suspected, but AP pelvic and lateral hip x-rays don’t show a fracture
When should CT be performed in hip fracture?
If MRI is not available within 24 hours or is contraindicated
How are intracapsular hip fractures managed?
Surgery
When should surgery be performed with intracapsular hip fractures?
Within 1 day of admission
What surgical treatment do undisplaced intracapsular hip fractures need?
Internal fixation with screws
What surgical treatment do displaced intracapsular hip fractures need?
Replacement of the femoral head with an arthroplasty (if the person is fit for the procedure)
What is the advantage of internal fixation in the management of hip fractures?
It is associated with less initiate operative trauma
What is the disadvantage of internal fixation in the management of hip fractures?
It has an increased risk of re-operation on the hip
When can total hip replacements be used for patients with displaced intracapsular fractures?
When patients;
- Are able to walk independantly out of doors with no more than a stick
- Are not cognitively impairment
- Are medically fit for anaesthesia and the operation
How are extracapsular hip fractures managed?
Surgically, unless there are medical contraindications
What is the surgical management for extracaspular hip fractures?
Usually treated by internal fixation, but hip arthroplasty may be used
Why is hip arthroplasty sometimes used over internal fixation in extracapsular hip fractures?
As internal fixation may fail, especially for unstable fractures
What is the mortality for hip fractures?
High, with about 10% of poeple with hip fracturs during within 1 month, and a third within 12 months.
What are the potential complications of hip fractures?
- Infection
- Haemorrhage
- Avascular necrosis
- Delayed union, malunion, and non-union
- Pneumonia
- Myocardial infarction
- Stroke
- DVT and pulmonary embolus
- Pressure ulcer
