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Lucy Knox - Year 2 > 218 - Hip Fracture > Flashcards

218 - Hip Fracture Flashcards

1
Q

What possible causes of an elderly person falling are there?

A

Medical issues
Dementia
Mechanical
Postrual hypotension

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2
Q

How do you asses postural hypotension?

A

Lying and standing Bp (must have been lying at rest for a while)

Tilt-test

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3
Q

What common drug may cause postural hypotension?

A

Bisoprolol

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4
Q

what is the mortality of hip fractures?

A

20%

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5
Q

What 4 steps can be taken to try prevent hip fractures?

A

Prevent osteoporosis
Treat osteoporosis
Prevent falls
Prevent injuries from falls

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6
Q

What is the definition of a fracture?

A

Loss of continuity of the substance of bone due to a physical force

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7
Q

What are the different configurations of fracture?

A

Long bone:

  • Transverse
  • Oblique
  • Spiral
  • Comminuted
  • Segmental

Cancellous bone:

  • impacted
  • crush/compression

Periarticular:
- avulsion

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8
Q

How do you describe a fracture?

A

Level - where it is - proximal 3rd? ephiphysial/metaphysial/diaphysial

Deformity:

  • Displacement
  • angulation
  • rotation
  • shortening
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9
Q

In a hip fracture what signs may you see?

A

Internal rotation
Shortening of leg
Pain

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10
Q

What do you need for normal bone healing?

A

Intact fracture haematoma

controlled micromovement

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11
Q

What are the 4 stages of normal bone healing?

A

Inflammation
Soft Callous
Hard Callous
Remodelling

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12
Q

What does a fracture haematoma contain?

A 
Inflammatory mediators
Fibrin clots
Polymorphs
Platelets
Monocytes
Fibroblasts - osteoprogenitor cells develop
- vascular ingrowth begins
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13
Q

What happens in the soft callus stage of bone healing?

A

Pain and swelling subside
boney fragments unite with fibrous/cartilaginous tissue
Ends fixed in place, but can still angulate

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14
Q

What happens in the hard callus stage of bone healing?

A

Mineralisation of cartilage
Osteoblast activity - woven bone
Stiffness increases
An external callus forms - can feel this

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15
Q

What happens in the remodelling stage of bone healing?

A

Bone remodels to form lamellar bone
Medullary canal is made
Occurs best in children
takes 1-2 years

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16
Q

What interventions are done in a fracture?

A
  • Reduction if needed
  • Retention - non-op (cast, strapping, traction), opperative (screws..)
  • Rehab - exercise limb. weight bearing good.
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17
Q

What operative retention methods of a fracture are there?

A

Plates + screws - eg. dynamic hip screw, cannulated screws
intramedullary screws
External fixtures
Percutaneous pins

18
Q

Why would you need to do operative retention of a fracture?

A

If there is a:

  • displaced intra-articular fracture
  • tenuous blood supply
  • Multiple injuries
  • in a pathological long bone
19
Q

What are possible complications of a fracture?

A 
General soft tissue damage
Fat embolism
Nerve damage
Vascular trauma
Compartment syndrome

Union problems - non-union, malunion, delayed union
AVN - Avascular necrosis

20
Q

What triad of effects do you see in a fat embolism?

A

Respiratory issues
Neurological issues
Petechial rash

21
Q

What are the 2 types of non-union? How do you approach them?

A

Hypertrophic - viable bone ends but not adequate stability -> achieve stability and let heal
Atrophic - no cellular activity in bone - > need bone grafting and removal of fibrous tissue

22
Q

What is AVN?

A

Avascular necrosis

  • Bone death due to blood supply disruption
  • Very slow revascularisation
  • Bone soft and easy to destroy
  • Pain + stiffness
23
Q

What are pathological fractures? Why do you get them?

A

Fracture are minimal stress

  • Primary tumours
  • Secondary tumours
  • Infection
  • Congenital (osteogenesis imperfecta)
  • Metabolic bone disorders
24
Q

Why are childrens fractures different from adults?

A

Periosteum is thicker
More metabolically active
Higher collagen: mineral content - more elastic and porous
Ligaments stronger than bone - physis is weak spot

25
Q

What type of fracture is common in children but not adukts?

A

Greenstick
- concave cortex is intact, convex side breaks
Plastic deformity

26
Q

Name 3 metabolic bone disorders

A

Osteoporosis
Osteomalacia/rickets
Paget’s disease

27
Q

What is osteoporosis?

A

Loss of bone mass

more osteoclast resorption than osteoblast formation

28
Q

What risk factors are there for osteoporosis?

A 
Age
female
genetics
oestrogen deficiency - early menopause, late menarche, tamoxifen
hypogonadism
smoking
alcohol
medications - steroids, anticonvulsants, SSRIs, PPIs
29
Q

What are protective against osteoporosis?

A

Weight bearing
physical activity
HRT while you take it

30
Q

How do you diagnose osteoporosis?

A

FRAX tool to asses risk
DEXA bone mineral density scan
- get T score, normal = 0 to -1, osteoporosis if <-2.5
- Z score is age + sex matched

31
Q

What are the treatment options for osteoporosis?

A 
Calcium + vit D
Exercise
Falls prevention measures
Increase bone formation:
- Teriparatide - PTH pulses
- Strontium renelate

Decreases bone resorption

  • Bisphosphonates: alendronate (inhibits osteoclasts)
  • Denosumab - RANK ligand inhibitor (prevents osteoclast differentiation)
32
Q

What is osteomalacia and rickets?

A

Vit D deficiency, in adults, in children

33
Q

Describe the steps that occur in vit D deficiency

A

Low vit D

  • > reduced Ca uptake from gut
  • > low serum Ca
  • > increase PTH
  • > Ca resporption form bone
  • > reduced mineralisation of bone
34
Q

What can cause a vit D deficiency?

A 
Inadequate sunlight/vit D in diet
malabsorption
Medication (phenytoin, rifampicin)
Multiparosity
Abnormal vit D metabolism
35
Q

What blood results would you see in osteomalacia.rickets?

A

Low serum 25(OH) vit D
Low serum Ca
Low serum phosphate

High serum PTH
High alkaline phospatase

36
Q

What signs do you see in rickets?

A

Curved long bones

37
Q

What signs do you see in osteomalacia?

A

Bone pain
Proximal muscle weakness
Stress fractures

38
Q

How do you treat osteomalacia/rickets?

A

Vit D supplements

  • calcichew
  • Oral D2/D3
  • Active Vit D - Alphacaleidol
39
Q

What is Pagets disease?

A

Disordered bone metabolism

Osteoclast overactivity and compensatory osteoblast activity - disordered woven bone - weaker

40
Q

What Symptoms do you get in pagets?

A

Bone pain
Pathological fractures
Compression effects - CN palises, deafness, siatica, cauda equina

41
Q

How do you diagnose Pagets?

A

X-Ray (often incidental)
Isotope bone scan - increased uptake
Urinary hydrocyproline increased
Bloods show: High alkaline phosphatase, but normal Ca, Vit D, PTH, phosphate.

42
Q

How do you treat pagets?

A

Not always necessary if not symptoms
Bisphosphinates
eg. risedronate, zolendronate

Lucy Knox - Year 2 (17 decks)

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