2: Proximal femoral fractures Flashcards
Who tends to have proximal femoral fractures?
Elderly women
“Proximal femoral” basically means ___ fracture.
hip
What are some risk factors for hip fracture?
Age
Osteoporosis
Smoking, alcohol
Malnutrition
Neuro, vision impairments
The risk of having a hip fracture ___ every 10 years after age 50.
doubles
Osteoporosis is more common in (men / women).
women
What is the proximal attachment of the vastus muscles?
Intertrochanteric line (anteriorly)
What is the equivalent of the intertrochanteric line posteriorly?
Intertrochanteric crest
The region below the greater and lesser trochanters is called the ___ region.
subtrochanteric
What does the hip capsule attach to
a) anteriorly
b) posteriorly?
a) Intertrochanteric line
b) Halfway up femoral neck (leaves a bit of space - important)
How does bone gain nutrition
a) within the capsule
b) within the joint?
a) Blood vessels from capsule
b) Synovial fluid
Which arteries supply the neck of the femur?
Deep femoral artery - medial and lateral circumflex arteries
What are the two types of proximal femoral fracture?
Intracapsular
Extracapsular
What other blood vessels, apart from the medial and lateral circumflex arteries, supply the neck of the femur?
Intramedullary arteries
What is a major complication of intracapsular fractures?
Loss of blood supply
Do extracapsular fractures disrupt blood supply?
Not enough to cause problems
How are intracapsular fractures further classified?
Undisplaced
Displaced (poor prognosis for healing)
What system is used to classify intracapsular fractures?
Garden system
How are extracapsular fractures further classified?
Basicervical (along base of neck / true neck of femur, look intracapsular but aren’t)
Intertrochanteric (along “ line)
Subtrochanteric
What are some complications of intracapsular fractures?
NON-UNION
Avascular necrosis
What is a possible complication of extracapsular fractures?
Malunion leading to poor functional outcome
What tends to cause a proximal femoral fracture?
What will the patient’s symptoms be following it?
Falls
Pain
Inability to weight bear on that side
What are some clinical signs of a proximal femoral fracture?
Limb shortening
External rotation of hip
Inability to SLR
How are suspected proximal femoral fractures investigated?
X-ray
MRI scan
Which line is interrupted on an AP X-ray in proximal femoral fractures?
Shenton’s line
If you’re not sure if there’s a fracture after looking at an X-ray, what should you do?
Get a lateral X-ray / another view
In young people or active older people, the preferred management for undisplaced fractures is…
fixation
e.g dynamic hip screws,
What is the management of hip fractures in old, inactive patients?
Usually THR
What is a possible complication of THR?
Higher dislocation rate than hemiarthroplasty
What is the name for half a joint replacement, sometimes given to patients with displaced intracapsular fractures?
Hemiarthroplasty
Hip replacement is generally more reliable than hemiarthroplasty. When is the latter indicated?
Patients with really poor function / cognitive deficit
Extracapsular fractures always have a good ___ potential.
healing
Do extracapsular fractures demand a hip replacement?
No, will always heal
How are extracapsular fractures treated?
Reduction ⇒ Fixation
as before, e.g dynamic hip screws, intramedullary nails
What does basicervical mean when referring to extracapsular fractures?
BASE of NECK of femur
What extends into the shaft of the femur and can be used to stabilise extracapsular fractures?
Intramedullary nail
What is the main goal of treatment after hip surgery?
Early mobility
to avoid pneumonia, pressure sores, UTIs
and joint stiffening
