Femoral Fractures

Question 1

Proximal femoral fracture types

Answer 1

Intracapsular: subcapital, transcervical, basicervical
Extracapsular: intertrochanteric, transtrochanteric, subtrochanteric

Question 2

Intracapsular fracture presentation

Answer 2

External rotation, adduction + shortening of leg

Question 3

Intracapsular fracture complications

Answer 3

AVN and non-union due to blood supply

Question 4

Intracapsular fracture treatment

Answer 4

Cannulated hip screw if undisplaced

Displaced # -> hemiarthroplasty or total hip replacement if fit+ambulant

Question 5

Extracapsular fracture treatment

Answer 5

Basicervical/intertrochanteric -> dynamic hip screw fixation (allows compression on weight bearing due to sliding screw)
Transtrochanteric/subtrochanteric -> Intramedullary nail

Question 6

Blood supply to femoral head

Answer 6

Medial femoral circumflex artery
Lateral femoral circumflex
Obturator artery through ligamentum teres
Retinacular arteries
Metaphyseal supply

Question 7

Femoral shaft fracture presentation

Answer 7

History of considerable trauma to femur
Proximal fragment flexed + adducted + laterally rotated
Distal fragment pulled up by hamstrings + adducted with external rotation

Question 8

Femoral shaft fracture complications

Answer 8

Sciatic nerve injury

Femoral artery injury

Question 9

Femoral shaft fracture treatment

Answer 9

Traction with Thomas splint

Locked intramedullary nail introduced proximally over guide wire

Question 10

Distal femoral/proximal tibial fracture types

Answer 10

Intra/extra-articular

Question 11

Tibial plateau fracture treatment

Answer 11

Type of intra-articular #, needs internal fixation with anatomically contoured locking plate
Hinged cast braces locked in extension can reduce chronic flexure contracture following tibeal plateau #