218 Hip # Flashcards by Jess Godfrey

Which anatomical landmark splits classification of NOF#’s?

Inter-trochanteric line

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What is the mortality rate in the first year following a fractured hip?

20%

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Which type of #NOF is Garden’s classification relevant for?

Intracapsular

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Which arteries supply the femoral head?

Medial and lateral femoral circumflex arteries + foveal artery (small proportion)

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What is a Garden type I NOF#?

Incomplete #, u displaced

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What is a Garden type II #?

Complete #, undisplaced

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What is a Garden type III NOF #?

Complete #, incompletely displaced

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What is a Garden type III NOF #?

Complete #, completely displaced

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What is the surgical option with undisplaced NOF extracapsular #’s?

Dynamic hip screw

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Which type of screws are added to DHS’s when there’s concern about rotational stability in #NOF?

Cannulated screws

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What are the 5 types of long bone #’s?

Transverse
Spiral 
Oblique
Comminuted 
Segmental

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What are the 4 types of deformities which can occur in #’s?

Displacement
Angulation
Rotation
Shortening (due to muscle action)

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What is periosteal elevation a sign of post fracture?

Fracture healing

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Name the 4 stages of fracture healing

Inflammatory
Soft callus
Hard callus
Remodelling

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In which stage of fracture healing do signs and symptoms subside? (i.e. Pain, loss of function, deformity, swelling, tenderness, bruising)

Soft callus

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In which stage of fracture healing do osteoblasts mineralise cartilage?

Hard callus formation

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What is the mediator for infiltration of inflammatory cells into fracture sites?

Prostaglandin

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In which stage of fracture healing is mechanical stress important?

Remodelling

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What is the mediator for recruitment of inflammatory cells into a haematoma of a fracture site?

Prostaglandins

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In which stage of # healing do fibroblasts lay down stroma to help vascular growth?

Soft callus

In which stage of fracture healing is smoking particularly harmful?

Soft callus stage - nicotine = vasoconstrictor

What happens in the hard callus stage of fracture healing?

Cartilage is mineralised into woven bone by osteoblasts

What facilitates the remodelling stage of fracture healing?

Mechanical stress

What type of fixation produces absolute stability of a fracture?

ORIF

Which group of patients is traction appropriate for?

Paeds - quick bone healing and therefore no risks of bed sores, institutionalisation... Etc which would happen in older pts

Which surgical option is appropriate for pathological fractures?

IM nails

What is THR treatment of infection following an open fracture?

Pain management Thorough debridement and skeletal stabilisation (6hrs) Early skin cover (72 hours)

What are the S&S of vascular trauma post fracture?

Pain Plum coloured/pale limb Pulselessness

What are the S&S of compartment syndrome?

Pain disproportional to injury and on passive stretching | Pins and needles + pulsessness are very late signs

Where is myositis ossificans commonly found?

Elbow and acetabulum

Which 4 bones are at risk of AVN if their blood supply is compromised?

Scaphoid Femoral head Talus Lunate

What are the 2 types of non-union? | Explain

``` Hypertrophic = increase of callus size due to too much movement - stabilise to allow healing Atrophic = cellular activity has ceased and bone ends are porotic - treat by removing fibrous tissue from ends and graft ```

Where are secondary bone mets most commonly found?

Proximal humerus, proximal femur

Where do secondary bone mets commonly arise from originally? (5 listed)

``` Breast Bronchus Prostate Kidney Thyroid ```

Which group of people tend to suffer from stress fractures?

Athletes

What are 'buckle', 'greenstick' and plastic deformation examples of?

Paediatric fractures

Name a group of drugs which can cause falls in the elderly

Psychotropic drugs, antiepileptics, antihypertensives

What does a T- score of -2.5 SD below the mean signify?

Osteoporosis

What does a Z score measure?

Bone mineral density to closest SD to an age and gender matched mean

Which group of patients is a Z score used for?

Children

What is the first line treatment for OP?

Alendronate - Bisphosphonate which decreases bone resorption

What is the MOA of the bisphosphonate alendronate? | 1st line Tx of OP

Inhibits FPP synthase which is required for osteoclast function, therefore inhibiting bone resorption

Name an example of a RANKL inhibitor used in the treatment of OP

Denosumab

What are the special instructions for taking alendronate?

Empty stomach Upright for half an hour Full glass of water NBM for half an hour

What is the rare but devastating side effect of alendronate?

Osteonecrosis of the jaw

What is the MOA of RANKL inhibitor Denosumab?

Prevents RANKL from activating its receptor RANK on the surface of osteoclasts and their precursors which interfere with their survival and function.

At which plasma concentration of vitamin D is osteomalacia and rickets a risk?

< 25 nmol/L

What happens in Paget's disease?

Disordered mosaic bone which is weaker than normal due to increased osteoclast activity and compensatory osteocblast activity.

What are risendronate and zolendronate examples of and what are they used to treat?

Bisphosphonates - to treat Paget's disease when symptomatic