Falls

Question 1

Risk factors for falls?

Answer 1

• inherent
• neurological
• chemical
• cardiovascular
• neuromuscular
• environmental
• psychological

Question 2

Intracapsular hip anatomy?

Answer 2

Head and neck
Above inter-trochantic

Question 3

Extracapsular hip anatomy?

Answer 3

Greater trochanter, lesser trochanter, shaft
Below intertrochanteric line

Question 4

Treatment for extracapsular fractures?

Answer 4

Dynamic hip screw - allows fracture to slide so promotes healing, suitable for intertrochanteric hip fracture
Intramedullary nail - to treat subtrochanteric fractures

Question 5

Retinacular vessels made up of?

Answer 5

Medial and lateral circumflex femoral arteries

Question 6

Bisphosphonates?

Answer 6

Bind to hydroxyapatite crystals, decrease rate of bone resorption and increase bone mineral density
Reduce fracture risk

Alendronic acid/alendronate - inhibits osteoclast-mediated bone resorption

Question 7

Zoledronic acid

Answer 7

Inhibits bone resorption by inhibiting osteoclastic activity

Question 8

Teriparatide

Answer 8

For advanced circumstance of osteoporosis, a portion of parathyroid hormone

Question 9

Denosumab?

Answer 9

Monoclonal antibodies that reduce osteoclast activity
For post menopausal women who have bisphosphonate intolerance

Question 10

DEXA scans?

Answer 10

Dual energy absorptiometry
Normal bone density <1
Osteopenia between -1 and -2.5
Osteoporosis >-2.5
For post menopausal women and men aged 50+

Question 11

Oestrogen deficiency?

Answer 11

Causes excessive bone resorption - bone cells express oestrogen receptors

Question 12

Oestrogen function?

Answer 12

Prevents bone loss through inhibition of osteoclastic bone resorption. Causes increased THF-B which increases osteoclast apoptosis.

Question 13

Mechanostat theory?

Answer 13

Bone structure is influenced by mechanical loading
Bone and muscle are related.

Question 14

Sarcopenia?

Answer 14

Progressive and generalised loss of skeletal muscle, mass and strength.
Leads to sarcopenic obesity as fat remains.

Question 15

Non-modifiable risk factors for fractures?

Answer 15

Age
Female gender
Caucasian ethnicity
FHx of hip fracture
PMH of hip fragility fractures
Abnormal bone

Question 16

Other risk factors?

Answer 16

Low BMI
Corticosteroid therapy
High alcohol intake
Smoking
Increased fall risk

Question 17

Surgical intervention for intracapsular displaced gardens III/IV

Answer 17

Total hip replacement - replaces acetabulum and head of femur
Hemi-arthroplasty - only head of femur is replaced, for patients with comorbidities and not fit for total replacement.

Question 18

Surgical intervention for intracapsular (undisplaced) gardens I/II?

Answer 18

Cannulated hip screws
Dynamic hip screw

Question 19

Delirium?

Answer 19

Acute onset, brains reaction to an underlying medical problem
Hypoactive (withdrawn and sleepy) or hyperactive (alert, restless, agitated, aggressive)

Question 20

Causes of delirium?

Answer 20

Pain
Infection
Nutrition
Constipation
Hydration

Medication
Electrolytes

Question 21

Intra-capsular fractures associated with?

Answer 21

Higher risk of disruption to femoral head due to close proximity of retinacular vessels