Applied anatomy of LL - Fractured NOF

Question 1

What is the socket of the shoulder called ?

Answer 1

The socket of the shoulder is called the glenoid and that of the hip is referred to as the acetabulum.

Question 2

What is the socket of the hip called ?

Answer 2

The socket of the shoulder is called the glenoid and that of the hip is referred to as the acetabulum.

Question 3

What are the important hip flexors ?

Answer 3

1- Psoas major muscle
2 - Illiacus

Question 4

What muscles are involved in hip extension ?

Answer 4

Gluteus Maximus

Question 5

What Muscles are involved in hip abduction ?

Answer 5

• Gluteus medius and Gluteus minimus

Question 6

What muscles are involved in hip rotation ?

Answer 6

Obturator internus and quadratus femoris.

Question 7

How likely is Hip to dislocate?

Answer 7

• UNLIKELY
• Alot of muscles and tendons keeping it in place.
• Can be difficult to manage.

Question 8

What is this ?

Answer 8

Left Neck of Femur (NOF) fracture

Question 9

What are the extracapsular fractures ?

Answer 9

Trochanteric
Transtrochanteric
Subtrochanteric

Question 10

What are the intracapsular NOF fractures ?

Answer 10

Intracapsular fractures:
Subcapital
Transcervical
Basal

Question 11

What are the problems associated with intracapsular NOF fractures ?

Answer 11

The blood supply is an important anatomical feature to address since this has a major impact on the treatment plan depending on the type of fracture.

Healing of bones requires a good blood supply. Femoral neck fractures tend to be intra-capsular and realignment of the bony fragments can be problematic. If the arterial vessels are ruptured this can lead to avascular necrosis of the femoral head. Early prosthetic replacement is often required following fractured neck of femurs.

Question 12

What is the major artery to supply blood to the NOF?

Answer 12

The medial and lateral circumflex femoral arteries anastomose to form a ring around the neck of the femur

Question 13

If intracapsular fractures lead to ruptures arterial vessels what can this lead to ?

Answer 13

avascular necrosis

Question 14

Why does a fractured NOF shorten and externally rotate ?

Answer 14

The classically described presentation is a shortened and externally rotated limb due to the unopposed pull of the iliopsoas muscle (illiacus and psoas mucle)

Question 15

If a Fractured NOF is intracapsular, what is the treatment?

Answer 15

• Hemiarthroplasty
• Because it wont heal on its own

Question 16

If a Fractured NOF is extracapsular, what is the treatment?

Answer 16

Dynamic hip screw

Question 17

When to suspect FRACTURED NOF as per NICE gudiance?

Answer 17

patient unable to weight bear
Unable to straight leg raise
high risk mechanism
severe osteoporosis
a feeling in your gut

Question 18

What is the chance someone is going to die within a year with a fractured NOF?

Answer 18

30%

Question 19

If an XRAY is normal, but you are considering a Fractured NOF, what should you do next ?

Answer 19

MRI