Banner- Hip Fracture Care Flashcards
1
Q
Do males or females most commonly get hip fractures? Do males or females most commonly die from hip fractures?
A
females
males
2
Q
Risk for hip fracture increases with age T or F?
A
T
3
Q
What are three major risk factors for hip fracture?
A
falls
osteoporosis
multiple medical conditions
4
Q
Why does hip fracture have a bimodal incidence?
A
because it happens in the elderly due to old age and all that comes with it and it happens to youngins due to high energy trauma
5
Q
What race is most likely to get hip fractures?
A
white
6
Q
T or F the incidence of hip fracture doubles each decade beyond age 50?
A
T
7
Q
T or F, having a small body size can increase your risk of hip fracture
A
T
8
Q
What are the three fracture types and what are the most common fractures?
A
(intertrochanteric) extracapsular fractures (55%) intracapsular fractures (45%) subtrochanteric fractures
9
Q
What are the three places you can get an intracapsular fracture?
A
femoral head
subcapital femoral neck
transcervical femoral neck
10
Q
What are the three places you can get an extracapsular fracture?
A
basicervical femoral neck
intertrochanteric
greater and lesser trochanteric
11
Q
the (blank) artery supplies the majority of the weight-bearing surface of the femoral head in more than 90% of adults.
A
lateral epiphyseal artery
12
Q
The greater the displacement in a femoral neck fracture, the greater the disruption of the (blank)
A
retinacular vessels
13
Q
For femoral neck fracture, what does treatment vary on? (4)
A
age of patient
displacement
fracture pattern
ability to mobilize patient early
14
Q
What are the treatment goals for a femoral neck fracture in the geriatric patient?
A
mobilize (weight bearing as tolerated, minimize period of bedrest)
minimize surgical morbidity (safest operation, decrease chance of reoperation)
15
Q
What are the treatment goals for a femoral neck fracture in young patients?
A
spare femoral head avoid deformity (improves union rate, optimal functional outcome) minimize vascular injury (avoid AVN)
16
Q
(blank) is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone.
A
Internal fixation
17
Q
Internal fixation of a femoral neck fracture has a reoperation rate of (blank) percent? is this significant?
A
18-47%
YOU BET!
18
Q
Is an intertrochanteric fracture intracapsular or extracapsular?
A
extracapsular
19
Q
What is this:
the major fracture line extends from proximal-medial to distal-lateral through intertroch-subtrochanteric region;
- marked tendency toward medial dispacement of shaft 2nd hip adductors;
A
reverse oblique fracture
20
Q
Are these stable intertrochanteric fractures or unstable: Unstable -posteriormodial comminution - reverse oblique - subtrochanteric extension
A
Unstable
21
Q
What is the lower limit of the intertrochanteric fracture?
A
inferior border of lesser trochanter
22
Q
What is this a sign of: Leg - shortened - externally rotated - groin pain with leg movement
A
femoral neck fracture
23
Q
Are you more likely or less likely to maintain blood supply to your head of your femur in an intertrochanteric (extracapsular) fracture or a femoral neck fracture (intracapsular)
A
intertrochanteric (extracapsular)
24
Q
What are the goals of treatment of an intertrochanteric (extracapsular) fracture?
A
optimization of medical comorbidities
minimize risk of medical complications
restore stability to allow early mobilization
25
Is the mortality rate high for intertrochanteric fractures?
yes it is 14-50%
26
Who are at increased risk for mortality in intertrochanteric fractures?
```
Medical comorbidities
Surgical delay > 3 days
Institutionalized / demented patient
Arthroplasty (short term / 3 months)
Posterior approach to hip
```
27
Hip fracture patients are at high risk for (blank)
venous thromboembolism
28
50% of hip fracture patients will get (blank) if they do not use prophylaxis.
DVT
29
2-8% of hip fracture patients will die of (blank) prior to surgery
PE
30
After hip fracture surgery, (blank) causes 15% of deaths
PE
31
What are factors that increase the risk of venous thromboembolism?
advanced age, delayed surgery, general anesthesia
32
What should be routinely used in the VTE prevention?
fondaprinux or LMWH or LDUH
33
What shouldnt you use by itself to prevent VTE?
ASA
34
INR stands for international normalized ratio. Its used to determine the clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status. Normal range for the INR is 0.8–1.2 but for therapeutic anti coagulation a higher INR range from (blank) to (blank) is considrered optimal when using anticoagulants such as warfarin
2-3
35
Can you use warfarin for VTE prevention?
absolutely
36
What should you do about VTE prevention of surgery is delayed?
give LDUH or LMWH preoperatively
37
If surgery isnt delayed, when should you begin anticoagulant admin to prevent VTE?
24 hours after surgery
38
If you have no drugs, what can you do to prevent VTE?
mechanical prophylaxis
39
How long should you keep the patients on anticoagulants after surgery?
10-35 days (possible longer)
40
What happens to your risk of getting another fracture if you have osteporosis?
it increased by a factor of 2.5
41
What are three things you should consider after surgery?
fall prevention, ensure safety in transition of care, pain management
42
out of all the people that get hip fractures, what fraction get hip replacement?
1/3rd
43
What percent of hospitalized patients have hip fractures?
30%
44
What might the decreased incidence of hip fracture be due to?
bisphosphonates
lifestyle changes:
calcium, vit D, less smoking, less drinking, fall awareness, exercise
45
What percent of hip fracture survivors are able to live independently after the fact?
50%
46
Who is most likely to get an intracapsular fracture?
white women
47
Who is most likely to get an intertrochanteric extracapsular fractures?
women
48
Who is most likely to get a subtrochanteric fracture?
20-40 yrs and over 60 years
49
Who is most likely to get an isolated trochanteric fracture?
young,active-> ages 14-25
50
85% of less severe trochanteric avulsions occurs in what age group?
under 20 years
51
What percent of fractures happens from falling from standing?
90%
52
What are three risk factors for elderly and hip fractures?
osteoporosis and falls
low SES
CVD and endocrine disorder
53
What is the blood supply to the femoral head?
extracapsular vascular ring
feeder vessels that run up to femoral head
medial and lateral femoral circumflex
supplemental flow from foveal artery (from obturator)
54
Can the obturator artery suffice for blood flow if you snap the neck of the femur?
no
55
If you have disruption of blood flow what can happen?
impaired healing, non union, AVN
56
What is the femoral head made up of?
cancellous bone
57
What does the primary medial trabeculae of the femoral head do? what does the primary lateral trabeculae of the femoral head do?
resists compression
| resists tension
58
What does the trabeculae of the femur head function together in doing?
endure strong forces across prox. femur
59
What is the intertrochanteric region made up of?
cancellous bone
60
Does the intertrochanteric region good at healing? Why?
yes because it has a good blood supply
61
Why can you get displacement with an intertrochanteric fracture?
due to pull of iliopsoas muscle and external rotator and abductor muscles (basically it makes you spread you legs)
62
Describe the consistancy of the femoral neck. What does this tell us?
littl cancellous bone, thin periosteum and poor blood supply
its more susceptible to AVN
63
Which has higher rates of nonunion, intracapsular or extracapsular?
intracapsular (femoral neck and head)
64
Where can an extracapsular break occur?
from extracapsular femoral head to inferior edge of lesser trochanter
65
What fracture needs the most implants and has a high failure rate due to stress?
subtrochanteric
66
What is the initial management of a fracture?
analgesia and consult an ortho
67
How should you give fracture patients drugs? What if you want less sedation?
IV opoids, IM or oral meds
| nerve block those fools
68
Who is at higher risk for hemorrhage?
over 75
hemoglobin below 12g/dl
peritrochanteric fracture
69
What is associated with fractures?
dehydration and rhabdomyolysis
70
Should you use traction for a fracture?
no there is no benefit
71
What are three ways you can get a femoral neck fracture?
fall on lateral hip
twisting mech-> foot is planted and body rotates
completion of fatigue fracture-> causes fall
72
How do young patients typically get a femoral neck fracture?
result of major trauma
| femur axially loaded and hip abducted
73
What does this describe:
| groin pain and leg externally rotated and shortened?
displaced intracapsular fracture
74
What does this describe:
| vague knee, butt, groin, thigh pain and no history of trauma
an insufficiency (fatigue) fracture
75
What kind of X-rays should you get for a femoral neck fracture?
AP (max internal rotation) and lateral views of hip
AP pelvis X ray to compare hips
evaluation of trabecular pattern, defects in cortex, and shortening/angulation of femoral neck
76
What is the normal angle b/w the neck and shaft on AP?
45 degrees
77
What is the normal angle b/w medial femoral shaft and trabecular lines?
160-170 degrees
78
What is a type 1 garden classificatin?
2?
3?
4?
Type 1- impaction fracture (partial fracture)
Type 2- nondisplaced fracture (complete fracture, no displacement)
Type 3- varus displacement of head (complete fracture with displacement but still touching)
Type 4- complete loss of continuity b/w fragments
(complete displacment not touching)
79
When do you give a bone scan or MRI?
when the plain film gives you nothing but you still have high suspicion.
80
What is a highlight of an MRI?
gives you earlier fracture detection and no radiation
81
What is sucky about a bone scan?
it may take 72 hours for injury to appear
82
If you have a femoral neck fracture, should you refer them to the ortho?
yes (most require surgery)
83
If your not sure if you should send the femoral neck fracture to the ortho what three things should you consider?
ambulation, overal function, medical comorbidities
84
If you have a patient who is ambulatory with femoral neck fracture what should you do?
```
send them to surgery and give them an open reduction with internal fixation (lower morbidity)
OR
an arthroplasty (lower reoperative rates, earlier recovery, reduced risk of AVN and nonunion)
```
85
If you have a debilitated pt (over 70 and poor health) who has a femoral neck fracture what should you do?
nonoperative management (higher rates of non union :/ )
86
What has higher rates of complications, extracapsular fractures or intracapsular fractures?
intracapsular
87
When should you be worried about non union?
Factors- age, bone density, fracture displacement, comminution, reduction quality, prosthetic device
Unresolved groin, hip, or thigh pain after surgery
88
What are some complications of intracapsular (femoral neck) fractues?
```
non union
AVN
nonunion
dislocation
arthritic changes
infection
thromboembolism
```
89
How should you screen for AVN and what does it present as?
x ray for 3 years
(keep close eye on patients with displaced fractures)
starts out initially painless and becomes painful and limits motion over time. You get groin pain or ipsilateral buttock pain. This pain increase with weight bearing and you get referred knee pain.
90
If you need a scan of a patient who has titanium in them, what do you use?
MRI
91
If you need a scan of a patient who has ferromagnetic hardware in them, what do you use?
bone scan
92
What does this describe
o Hip pain, swelling, and ecchymosis (bruises)
o Displaced fracture leg shortened and externally rotated
o Tenderness over trochanteric area
intertrochanteric fracture
93
What x rays should you get for an intertrochanteric fracture?
o AP (max internal rotation) and lateral views
o Compare to unaffected hip
o If unrevealing- same approach as femoral neck fractures
94
What makes an intertrochanteric stable?
| Unstable?
Stable-> anatomic reduction achievable (restore to correct alignment)
unstable-> displacement, comminution, multiple fracture lines
95
When should you refer an intertrochateric fracture to an ortho?
Always
96
How do you treat an intertrochanteric fracture?
All treated with open reduction and internal fixation
| • Higher mortality in closed treatment (nonoperative)
97
When do you treat intertrochateric fractures nonoperatively?
Nonambulatory or demented w/ mild pain
Old nondisplaced or impacted fractures w/mild pain
Unstable pt w/ major, uncorrectable comorbidity
At end stages of terminal illness
98
When is surgery delayed for intertrochanteric fractures?
for sepsis or skin breakdown over surgical site
99
What are some complications of intertrochanteric fractures?
heal well, lower rates of nonunion but still possible, HOWEVER worse overall mortality and functional outcome compared to femoral neck fractures, AVN, and high fixation failure (varus collapse of proximal fragment and cutout of compression screw)
100
What are isolated fractures of greater or less trochanters?
trochanteric fractures
101
How do you get a trochanteric fracture?
forceful muscular contraction of fixed limb in young, active adults or avulsion fracture
102
How do you get an avulsion in a trochanteric fracture?
iliopsoas -lesser trochanter
| hip abductors or fall – greater
103
What x rays should you get for a trochanteric fracture?
o AP and lateral
o For lesser T- AP with leg in external rotation
o MRI for pt at high risk of extension of trochanteric fracture such as elderly or decreased bone density
104
In elderly, what is lesser trochanteric fracture associated with? what if there is no trauma?
pathology
| evaluate for metastases
105
What are the complication of fractures?
direct comps are rare
slight loss of abduction (greater T fracture)
slight loss of flexion (lesser T fracture)
joint contracture with prolonged immobilization
106
if you have swelling, bruising (ecchymosis) what do you have?
intertrochanteric fracture
