Clinical anatomy

Question 1

Janice is brought to A&E by ambulance after a fall. The registrar orders an X-Ray, which revealed an intracapsular fracture as well as some osteoarthritic changes.

What is the best course of treatment for Janice? Why?

Answer 1

Total arthroplasty

Blood supply is compromised - arthroplasty

Osteoarthritic changes in acetabular - total

Question 2

What type of intracapsular fracture does Janice’s X-ray show?

Answer 2

subcapital fracture of the left femur

Question 3

What osteoarthritic changes can be seen on this patient’s x-ray?

Answer 3

• joint space narrowing
• scleorsis - thickening of bone at joint margins
• osteophytes - new bone fomration (irregular bony spurs)
• subchondral lucency - loss of bone density

Question 4

The hip joint is a ball and socket synovial joint. What are the common features of synovial fluid and how are these affected in osteoarthritis?

Answer 4

• synovial fluid nourishes joint cartilage
• synovial fluid acts as a lubricant to protect the cartilage when two bones articulate
• In OA, cartilage is subjected to microtrauma
• the synovial membrane responds by producing more fluid to bathe inflamed surfaces
• Sfluid is not recycled properly and the cartilage is undernourished
• this results in accumulation of spent fluid and further degradation of cartilage

Question 5

Janice’s fracture is in the neck of femur within the capsule.

What is the risk of pinning the fracture instead of replacing the head entirely?

Answer 5

• retinacular vessels are likely disrupted
• this will lead to ischaemia of the femoral head
• and avascular necrosis

Question 6

If Janice’s fracture was inter-trochanteric, would the risk of avascular necrosis be greater or lesser? Why?

Answer 6

Lesser, as the retinacular vessels would be unaffected