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TRAUMA & ORTHO > 1: Hip Fractures & Conditions > Flashcards

1: Hip Fractures & Conditions Flashcards

1
Q

what are NOF fractures commonly caused by

A
  • low energy injuries i.e. falls in frail older patient
  • high energy injuries e.g. road traffic collision or fall from height
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2
Q

what are major risk factors for hip fractures

A
  • increasing age
  • osteoporosis
  • F>M
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3
Q

why are hip fractures prioritised on the trauma list and when should they aim to be performed

A

↑ morbidity and mortality
- aim to perform within 48 hours

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4
Q

how can hip fractures be categorised

A
  1. intracapsular: proximal to the intertrochanteric line
  2. extracapsular
    - intertrochanteric: between greater trochanter and lesser trochanter
    - sub trochanteric: from lesser trochanter to 5cm distal to this point
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5
Q

basic anatomy of the femur

A
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6
Q

describe the blood flow to the NOF

A

retrograde: passes from distal to proximal along the femoral neck to the femoral head
- MCFA which lies directly on the intracapular femoral neck
- supply from ligamentum arteriosum in l.teres but this is insufficient to maintain supply in adults

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7
Q

what is there risk of in an intracapsular #NOF

A

avascular necrosis

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8
Q

what will patients with a displaced intracapsular #NOF require

A

hemiarthroplasty or THR

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9
Q

how can intracapsular fractures be further classified

A

Garden classification

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10
Q

what is the Garden classification for intracapsular hip fractures

A
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11
Q

what is the difference in approach to displaced vs non-displaced intracapsular fractures

A
  • non displaced may still have an intact blood supply so no avascular necrosis = internal fixation with screws to hold femoral head in place while fracture heals
  • displaced will disrupt blood supply = hemiarthroplast/THR
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12
Q

describe the difference between hemiarthroplasty and total hip replacement

A
  • hemiarthroplasty: replace head of femur but acetabulum remains in place and cement used to hold the stem of prosthesis in shaft of femur (pt with limited mobility/significant co-morbidities)
  • total hip replacement: replace both head of femur and socket (pt who can walk independently and fit for surgery)
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13
Q

how can extracapsular fractures be treated

A

intertrochanteric: dynamic hip screw (sliding hip screw) through the neck and into head of femur
- plate with a barrel which holds screw is screwed to the outside of the femoral shaft
- screw through head allows controlled compression at fracture site which improves healing

subtrochanteric: intramedullary nail with is inserted through the g.troch into central cavity of shaft

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14
Q

what is the typical presentation of a hip fracture

A
  • pain in groin/hip which can commonly radiate to knee in elderly
  • NWB
  • shortened, abducted, externally rotated
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15
Q

what factors are important to identify in patients presenting with hip fractures

A

any underlying reversible causes for a ‘mechanical fall’ e.g. anaemia, arrhythmias or Parkinson’s

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16
Q

what is a key sign of a #NOF on AP X-ray

A

displaced Shenton’s line
- formed by medial edge of the femoral neck and the inferior edge of the superior pubic ramus

17
Q

what are long term complications following #NOF repair

A
  • joint dislocation
  • aseptic loosening
  • peri-prosthetic fracture
  • deep infection/prosthetic joint infection
18
Q

what is the most common mechanism of femoral shaft fractures (4)

A
  • high energy trauma
  • fragility fractures in elderly
  • pathological fractures
  • bisphosphonate related fractures
19
Q

what is a potential consequence of a femoral shaft fracture and why

A

the femur is a highly vascularised bone due to its role in heamtopoeisis
- supplied by penetrating branches of the profunda femoris artery so large volumes of blood can extravasate if fractured

20
Q

how will a patient with a femoral shaft fracture present

A
  • pain/swelling in thigh, hip, and/or knee pain
  • NWB
  • obvious deformity in most cases
  • skin may be open or threatened
21
Q

what happens to the proximal fragment in a femoral shaft fracture

A

pulled into flexion and external rotation by iliopsoas and glut med/min
- can further tent the skin

22
Q

what system is used to classify the degree of comminution to femoral shaft fractures

A

Winquist and Hansen Classification
* Type 0 – No comminution
* Type I – Insignificant amount of comminution
* Type II – Greater than 50% cortical contact
* Type III – Less than 50% cortical contact
* Type IV – Segmental fracture with no contact between proximal and distal fragment

23
Q

what is the management of a femoral shaft fracture

A
  • A-E assessment and stabilise patient
  • adequate pain relief
  • immediate reduction and immobilisation using in-line traction to ensure appropriate haemtoma formation and pain reduction
  • surgery - but long leg casts may be indicated in undisplaced femoral shaft fractures
24
Q

how does traction splinting work

A

e.g. Kendrick traction splint
- used in suspected or isolated fractures of the mid-shaft femur
- act to hold femur in correct position against the action of the large thigh muscle mass

25
Q

when is traction splinting used

A

pre-hospital setting
- should not be in place any longer than necessary due to risk of skin necrosis at groin

26
Q

what are contraindications for traction splinting

A
  • hip/pelvic fractures
  • supracondylar fractures
  • ankle/foot fractures
  • partial amputation
27
Q

what is the surgical management of a femoral fracture

A

24-48 hours but sooner if open fracture
- antegrade IM nail (98% union rate and low rate of post-op complications)

28
Q

what are common complications following femoral shaft fracture

A
  • Nerve injury or vascular injury
  • Pudendal nerve injury (around 10%) or femoral nerve injury (rare)
  • Mal-union (or rotational mal-alignment), delayed union, or non-union
    - occurs in around 30% and 10% of proximal and distal fractures respectively
  • Infection, especially with open fractures
  • Fat embolism
  • Venous thromboembolism
29
Q

A 6 year old boy presents with progressive hip pain for last few weeks associated with a limp is a common presentation for which condition

A

Perthes disease

30
Q

What are features of Perthe’s disease

A

Degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years due to avascular necrosis of the femoral head
- presents with gradual hip pain and limp
- stiff and reduced ROM
- X-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening

31
Q

what is development dysplasia of the hip

A

socket of the hip is too shallow and the femoral head is not held tightly in place, so the hip joint is loose
- more common in left hip

32
Q

What signs will be positive in DDH

A

Barlow’s test, Ortolani’s test are positive
- picked up on newborn examination

33
Q

Describe transient synovitis (irritable hip)

A
  • typical age 2-10 years
  • acute hip pain assoc with viral infection
  • most common cause of hip pain in children
34
Q

What is the most appropriate method of analgesia for a patient with #NOF

A

Iliofascial nerve block

35
Q

Describe slipped upper femoral epiphysis

A
  • age 10-15
  • more common in obese males
  • displacement of femoral head epiphysis postero-inferiorly
  • bilateral slip in 20% of cases
  • knee or distal thigh pain is common
36
Q

how does avascular necrosis of the hip present

A
  • buttock or groin pain
  • reduced mobility
37
Q

what are causes of avascular necrosis of the hip

A
  • long term steroids
  • chemo
  • trauma
  • alcohol excess
38
Q

what are the x-ray findings of avascular necrosis of the hip

A

irregular borders of the articular surface with sclerosis of the femoral head

TRAUMA & ORTHO (11 decks)

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