Femoral fractures

Question 1

What is the pathophysiolgy of femoral fractures?

Answer 1

Young p’s - Severe trauma eg RTC

Older p’s - Minor trauma eg fall due to osteoporosis

Question 2

What are the risk factors for Osteoporosis? SHATTERED

Answer 2

Old age + SHATTERED
S - Steroids
H - Hyper para/thyroidism
A - Alcohol/Smoking
T - Thin 
T - Testosterone low
E - Early menopause
R - Renal/Liver failure
E - Erosive/inflammatory bone disease eg RA, Psoriasis
D - Dietary - low Ca2+/Malabsorption, DM

Question 3

How does a femoral fracture present?

Answer 3

Shortened + externally rotated limb
Hx of trauma/osteoporosis
Pain on wt bearing

Question 4

What is the initial management for a patient with femoral fracture?

Answer 4

Resuscitate - may be dehydrated or have hypothermia
Morphine (up to 10mg every 4 hrs) + antiemetic (Ondansetron 16mg every 4 hrs)
Assess NV status of limb
AP + lateral view
Prep for theatre - ABCDEFG
A - Anaesthetist, B - Bloods (FBC, U+Es, Clotting, Cross match), C - CXR, D - DVT prohylaxis, E - ECG, F - Films, G - Gain consent

Question 5

What blood vessels may be damaged in an intracapsular fracture?

Answer 5

Medial circumflex artery of head of the femur (Does majority of blood supply to head)
Risk of AVN

Question 6

What fractures of the femur would be classified as intracapsular?

Answer 6

Subcapital
Transcervical
Basicervical

Question 7

What fractures of the femur would be classified as extracapsular?

Answer 7

Intertrochanteric

Subtrochanteric

Question 8

What is Garden’s classification?

Answer 8

Used to classify intracapsular fractures of the femur

Question 9

What is the Nottingham hip score?

Answer 9

Used to classify femoral fractures - used to predict 30 day mortality and 1 year mortality
Looks at age, sex, admission Hb, living in an institution, no. of comorbidities, Malignanacy, Mini mental test score

Question 10

What is the surgical management of an intracapsular incomplete (or complete), undisplaced fracture of the femur?

Answer 10

ORIF with cancellous screws

Question 11

What is the surgical management of an intracapsular complete fracture of the femur, displaced or partially displaced?

Answer 11

75 or poor mobility - hemirthroplasty, cemented - mobiliser, uncemented - non mobiliser

Question 12

What is the surgical management of an extracapsular fracture of the femur?

Answer 12

DHS

Question 13

What complications can occur after a femoral fracture?

Answer 13

AVN of the head if intracapsular
Malunion/Nonunion
Infection
OA

Question 14

What do all patients post hip surgery have?

Answer 14

OT + physio involvement

When mobility has improved, can discharge if social circumstances allow