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Orthobullets Trauma > Femoral Neck Fractures > Flashcards

Femoral Neck Fractures Flashcards

1
Q

femoral neck is ______, bathed in synovial fluid

A

intracapsular

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2
Q

femoral neck lacks _____ layer

A

periosteal

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3
Q

____ formation limited, which affects healing

A

callus

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4
Q

mechanism of injury

A

high energy in young patients
low energy in older patients

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5
Q

associated injuries

A

femoral shaft fracture

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6
Q

do you treat the neck or the shaft first?

A

neck

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7
Q

what percentage of femoral neck fractures have an associated femoral shaft fracture?

A

6-9%

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8
Q

what is the normal neck shaft angle

A

130 +/- 7

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9
Q

what is normal anteversion

A

10 +/- 7 degrees

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10
Q

major contributor to blood supply of femoral head is _____ (lateral epiphyseal artery)

A

medial circumflex femoral

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11
Q

some contribution to anterior and inferior head from ____ femoral circumflex

A

lateral

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12
Q

some contribution to blood supply of head from ____ artery

A

inferior gluteal

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13
Q

displacement of femoral neck fracture will disrupt the blood supply and cause an ______

A

intracapsular hematoma

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14
Q

where is the pain in impacted and stress fractures?

A

slight pain in the groin or pain referred along the medial side of the thigh and knee

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15
Q

where is the pain in displaced fractures

A

pain in the entire hip region

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16
Q

physical exam of impacted and stress fractures

A

no obvious clinical deformity
minor discomfort with active or passive hip range of motion, muscle spasms at extremes of motion
pain with percussion over greater trochanter

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17
Q

no obvious clinical deformity
minor discomfort with active or passive hip range of motion, muscle spasms at extremes of motion
pain with percussion over greater trochanter

A

impacted and stress fractures

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18
Q

pain in the entire hip region

A

displaced fracture

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19
Q

slight pain in the groin or pain referred along the medial side of the thigh and knee

A

impacted and stress fractures

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20
Q

leg in external rotation and abduction, with shortening

A

displaced fracture

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21
Q

displaced fracture physical exam

A

leg in external rotation and abduction, with shortening

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22
Q

Xray views

A

AP
cross table lateral
full length femur

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23
Q

_____ AP hip is best for defining fracture type

A

traction-internal rotation

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24
Q

CT is useful for what

A

helpful in determining displacement and degree of comminution in some patients

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25
Q

helpful in determining displacement and degree of comminution in some patients

A

CT

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26
Q

why is MRI useful

A

helpful to rule out occult fracture

not helpful in reliably assessing viability of femoral head after fracture

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27
Q

helpful to rule out occult fracture

not helpful in reliably assessing viability of femoral head after fracture

A

MRI

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28
Q

do this to rule out DVT if delayed presentation to hospital after hip fracture

A

duplex scanning

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29
Q

non op/observation indications

A

may be considered in some patients who are non-ambulators, have minimal pain, and who are at high risk for surgical intervention

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30
Q

ORIF indications

A

displaced fractures in young or physiologically young patients
ORIF indicated for most pts <50 years of age

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31
Q

displaced fractures in young or physiologically young patients
indicated for most pts <50 years of age

A

ORIF

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32
Q

____ sex has highest reoperation rate

A

female

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33
Q

nondisplaced transcervical fx
Garden I or II in the physiologically elderly
displaced transcervical fx in young patient

A

cannulated screws

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34
Q

indications for cannulated screws

A

nondisplaced transcervical fx
Garden I or II in the physiologically elderly
displaced transcervical fx in young patient

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35
Q

indications for sliding hip screw

A

basicervical fracture
vertical fracture pattern in a young patient

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36
Q

basicervical fracture
vertical fracture pattern in a young patient

A

sliding hip screw

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37
Q

are sliding hip screws or cannulated screws biomechanically superior?

A

sliding

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38
Q

consider placement of additional cannulated screw above sliding hip screw to prevent ____

A

rotation

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39
Q

controversial
debilitated elderly patients
metabolic bone disease

A

hemiarthroplasty

40
Q

indications for hemiarthroplasty

A

controversial
debilitated elderly patients
metabolic bone disease

41
Q

decreased fracture rates
improved short and medium term mobility

A

cemented hemiarthroplasty

42
Q

cemented hemiarthroplasty pros

A

decreased fracture rates
improved short and medium term mobility

43
Q

indications for total hip arthroplasty

A

older active patients
patients with preexisting hip osteoarthritis
Garden III or IV in patient < 85 years

44
Q

older active patients
patients with preexisting hip osteoarthritis
Garden III or IV in patient < 85 years

A

total hip arthroplasty

45
Q

does a hemi or total hip have more predictable pain relief and better functional outcome

A

total hip

46
Q

_____ has more pronounced effect on healing than surgical timing

A

reduction method and quality

47
Q

elderly patients with hip fractures should be brought to surgery as soon as _____

A

medically optimal

48
Q

the benefits of early ____ cannot be overemphasized

A

mobilization

49
Q

improved outcomes in medically fit patients if surgically treated less than _____ days from injury

A

4

50
Q

preoperative ____ have been shown to delay the time to surgery without any effect on treatment decisions

A

echocardiograms

51
Q

treatment approach based on:

A

degree of displacement
physiologic age of the patient (young is < than 50 years old)
ipsilateral femoral neck and shaft fractures

52
Q

priority goes to fixing femoral neck because anatomic reduction is necessary to avoid complications of _____

A

AVN and nonunion

53
Q

permit dynamic compression at fx site during axial loading
can cause shortening of femoral neck

A

fixation with implants that allow sliding

54
Q

fixation with implants that allow sliding can lead to

A

permit dynamic compression at fx site during axial loading
can cause shortening of femoral neck

55
Q

multiple closed reduction attempts are associated with higher risk of _____ of the femoral head

A

osteonecrosis

56
Q

10cm skin incision made beginning just distal to AIIS
incise deep fascia
develop interval between sartorious and TFL
external rotation of thigh accentuates dissection plane
LFCN is identified and retracted medially with sartorius
identify tendinous portion of rectus femoris, elevate off hip capsule
open capsule to identify femoral neck

A

anterior smith Peterson approach

57
Q

steps in anterior smith Peterson approach

A

10cm skin incision made beginning just distal to AIIS
incise deep fascia
develop interval between sartorious and TFL
external rotation of thigh accentuates dissection plane
LFCN is identified and retracted medially with sartorius
identify tendinous portion of rectus femoris, elevate off hip capsule
open capsule to identify femoral neck

58
Q

anterior approach interval

A

sartorius and TFL

59
Q

steps to Watson approach

A

used to gain improved exposure of lower femoral neck fractures
skin incision approx 2cm posterior and distal to ASIS, down toward tip of greater trochanter
incision curved distally and extended 10cm along anterior portion of femur
incise deep fascia
develop interval between TFL and gluteus medius
anterior aspect of gluteus medius and minimus is retracted posteriorly to visualize anterior hip capsule
capsule sharply incised with Z-shape incision
capsulotomy must remain anterior to lesser trochanter at all times to avoid injury to medial femoral circumflex artery

60
Q

used to gain improved exposure of lower femoral neck fractures
skin incision approx 2cm posterior and distal to ASIS, down toward tip of greater trochanter
incision curved distally and extended 10cm along anterior portion of femur
incise deep fascia
develop interval between TFL and gluteus medius
anterior aspect of gluteus medius and minimus is retracted posteriorly to visualize anterior hip capsule
capsule sharply incised with Z-shape incision
capsulotomy must remain anterior to lesser trochanter at all times to avoid injury to medial femoral circumflex artery

A

Watson approach

61
Q

Watson approach interval

A

TFL and gluteus medius

62
Q

screw fixation: inverted triangle along the calcar (not central in the neck) has stronger fixation and higher ____

A

load to failure

63
Q

where is the first screw placed when doing cannulated screw fixation?

A

inferior screw along calcar

64
Q

where is the second screw placed when doing cannulated screw fixation?

A

posterior/superior screw

65
Q

where is the third screw placed when doing cannulated screw fixation?

A

anterior/superior screw

66
Q

how many screws are normally placed?

A

3

67
Q

four screws considered for ____

A

posterior comminution

68
Q

cannulated screw fixation starting point at or above level of ____ to avoid fracture

A

lesser trochanter

69
Q

cannulated screw fixation: avoid multiple cortical perforations during guide pin or screw placement to avoid development of _____

A

lateral stress riser

70
Q

posterior hemi approach has higher risk of

A

dislocation

71
Q

anterolateral approach to hemi has increased ____ weakness

A

abductor

72
Q

total hip-should consider using the _____ approach and selective use of larger heads in the setting of a femoral neck fracture

A

anterolateral

73
Q

complications of total hip

A

5x higher rate of dislocation compared to hemi

74
Q

complications of femoral neck fractures

A

osteonecrosis
nonunion
dislocation
failure
loss of independence

75
Q

osteonecrosis incidence

A

10-45%

76
Q

increased risk of osteonecrosis associated with _____

A

increase initial displacement
nonanatomical reduction
sliding hip screw

77
Q

treatment of osteonecrosis in a young patient

A

> 50% involvement treat with FVFG vs THA

78
Q

treatment of osteonecrosis in an older patient

A

prosthetic replacement (hemiarthroplasty vs THA)

79
Q

nonunion incidence

A

5-30%

80
Q

increased incidence of nonunion in ____ fractures

A

displaced

81
Q

_____ malreduction most closely correlates with failure of fixation after reduction and cannulated screw fixation

A

varus

82
Q

treatment of nonunion options

A

valgus intertrochanteric osteotomy
FVFG
arthroplasty
revision ORIF

83
Q

turns vertical fx line into horizontal fx line and decreases shear forces across fx line

A

valgus intertrochanteric osteotomy

84
Q

FVFG nonunion fixation indications

A

indicated in young patients with a viable femoral head

85
Q

indicated in young patients with a viable femoral head

A

FVFG

86
Q

indicated in older patients or when the femoral head is not viable
also an option in younger patient with a nonviable femoral head as opposed to FVFG

A

arthroplasty

87
Q

arthroplasty as nonunion treatment indications

A

indicated in older patients or when the femoral head is not viable
also an option in younger patient with a nonviable femoral head as opposed to FVFG

88
Q

are overall failure rates higher in fixation or arthroplasty?

A

fixation

89
Q

important to mitigate risks of hospital ____ which may lead to increased length of stay

A

delirium

90
Q

the _____ test has been identified as a reliable predictor of a patient’s need for post-operative assistive devices

A

timed up and go (TUG)

91
Q

Normal TUG is <_____ seconds in all age groups

A

12

92
Q

Persistent use of ambulatory aids is predicted if TUG > _____ seconds

A

26

93
Q

loss of independence associated factors

A

age >80 years
ASA class >1
prior walking aid use
current tobacco use
implant placement quality
nondisplaced fracture
not requiring revision surgery

94
Q

mortality rate

A

25-30% at 1 year

95
Q

_____ is the most significant determinant for post-operative survival

A

pre-injury mobility

96
Q

in patients with chronic renal failure, rates of mortality at 2 years postoperatively, are close to ____%

A

45

97
Q

mortality risk is decreased at 30 days and at 1 year post-op when surgical intervention is performed within ____

A

24 hours of admission

Orthobullets Trauma (63 decks)

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