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MSK Week 6 2017/18 > 2: Proximal femoral fractures > Flashcards

2: Proximal femoral fractures Flashcards

1
Q

Who tends to have proximal femoral fractures?

A

Elderly women

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2
Q

“Proximal femoral” basically means ___ fracture.

A

hip

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3
Q

What are some risk factors for hip fracture?

A

Age

Osteoporosis

Smoking, alcohol

Malnutrition

Neuro, vision impairments

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4
Q

The risk of having a hip fracture ___ every 10 years after age 50.

A

doubles

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5
Q

Osteoporosis is more common in (men / women).

A

women

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6
Q

What is the proximal attachment of the vastus muscles?

A

Intertrochanteric line (anteriorly)

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7
Q

What is the equivalent of the intertrochanteric line posteriorly?

A

Intertrochanteric crest

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8
Q

The region below the greater and lesser trochanters is called the ___ region.

A

subtrochanteric

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9
Q

What does the hip capsule attach to

a) anteriorly
b) posteriorly?

A

a) Intertrochanteric line

b) Halfway up femoral neck (leaves a bit of space - important)

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10
Q

How does bone gain nutrition

a) within the capsule
b) within the joint?

A

a) Blood vessels from capsule

b) Synovial fluid

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11
Q

Which arteries supply the neck of the femur?

A

Deep femoral artery - medial and lateral circumflex arteries

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12
Q

What are the two types of proximal femoral fracture?

A

Intracapsular

Extracapsular

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13
Q

What other blood vessels, apart from the medial and lateral circumflex arteries, supply the neck of the femur?

A

Intramedullary arteries

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14
Q

What is a major complication of intracapsular fractures?

A

Loss of blood supply

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15
Q

Do extracapsular fractures disrupt blood supply?

A

Not enough to cause problems

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16
Q

How are intracapsular fractures further classified?

A

Undisplaced

Displaced (poor prognosis for healing)

17
Q

What system is used to classify intracapsular fractures?

A

Garden system

18
Q

How are extracapsular fractures further classified?

A

Basicervical (along base of neck / true neck of femur, look intracapsular but aren’t)

Intertrochanteric (along “ line)

Subtrochanteric

19
Q

What are some complications of intracapsular fractures?

A

NON-UNION

Avascular necrosis

20
Q

What is a possible complication of extracapsular fractures?

A

Malunion leading to poor functional outcome

21
Q

What tends to cause a proximal femoral fracture?

What will the patient’s symptoms be following it?

A

Falls

Pain

Inability to weight bear on that side

22
Q

What are some clinical signs of a proximal femoral fracture?

A

Limb shortening

External rotation of hip

Inability to SLR

23
Q

How are suspected proximal femoral fractures investigated?

A

X-ray

MRI scan

24
Q

Which line is interrupted on an AP X-ray in proximal femoral fractures?

A

Shenton’s line

25
Q

If you’re not sure if there’s a fracture after looking at an X-ray, what should you do?

A

Get a lateral X-ray / another view

26
Q

In young people or active older people, the preferred management for undisplaced fractures is…

A

fixation

e.g dynamic hip screws,

27
Q

What is the management of hip fractures in old, inactive patients?

A

Usually THR

28
Q

What is a possible complication of THR?

A

Higher dislocation rate than hemiarthroplasty

29
Q

What is the name for half a joint replacement, sometimes given to patients with displaced intracapsular fractures?

A

Hemiarthroplasty

30
Q

Hip replacement is generally more reliable than hemiarthroplasty. When is the latter indicated?

A

Patients with really poor function / cognitive deficit

31
Q

Extracapsular fractures always have a good ___ potential.

A

healing

32
Q

Do extracapsular fractures demand a hip replacement?

A

No, will always heal

33
Q

How are extracapsular fractures treated?

A

Reduction ⇒ Fixation

as before, e.g dynamic hip screws, intramedullary nails

34
Q

What does basicervical mean when referring to extracapsular fractures?

A

BASE of NECK of femur

35
Q

What extends into the shaft of the femur and can be used to stabilise extracapsular fractures?

A

Intramedullary nail

36
Q

What is the main goal of treatment after hip surgery?

A

Early mobility

to avoid pneumonia, pressure sores, UTIs

and joint stiffening

MSK Week 6 2017/18 (6 decks)

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