Chapter 99 - Fractures of the Hip

Question 1

what is the disadvantage of using a direct anterior approach to the hip for ORIF of a femoral neck?

Answer 1

you must also use a laterally based incision for all instrumentation/hardware

Question 2

internervous plane for a watson-jones/anterolateral approach to the hip?

Answer 2

trick question both glute med and tfl are innervated by the superior gluteal nerve

Question 3

mean femoral neck shaft angle?

Answer 3

130 +/- 7

Question 4

mean femoral anteversion

Answer 4

10 +/- 7

Question 5

trabecular bone patterns in the proximal femur are representative of what?

Answer 5

wolff’s law - bone remodels in response to stress

Question 6

compression side, tension side and ward’s triangle - describe them

Answer 6

compression side - along calcar
tension side - along superior neck
wards triangle - weakest area of the femoral neck

Question 7

what is the relationship between comorbidities and post-hip fracture one year mortality rate

Answer 7

4+ comorbidities = increased one year mortality rate compared to thos with three or fewer co-morbidities

Question 8

how should a basicervical femoral neck be treated?

Answer 8

like an intertroch fracture - however they have less inherent rotational stability than an intertroch
- treat with a SHS and a detrotational screw

Question 9

how to treat a femoral neck non-union

Answer 9

valgus intertroch osteotomy -> blade plate

Question 10

instability in intertrochanteric fractures is based on what feature

Answer 10

posteromedial comminution -> tendency to fall into varus and retroversion

Question 11

what are the surgical indications for greater trochanter fixation

Answer 11

> 1cm displacement in a young, active person

Question 12

if you see an isolated lesser trochanter fracture, you should be thinking of what?

Answer 12

1. ilipsoas avulsion if a kid
2. pathologic fracture if an adult