Femoral Neck Fractures

Question 1

How does age affect risk? (2)

Answer 1

1 Increases exponentially with age 2 in elderly

Question 2

Affect of bone mass on risk

Answer 2

Decreased bone mass, increased risk

Question 3

Aetiology in elderly

Answer 3

Low energy fall onto side

Question 4

Aetiology in young

Answer 4

High energy trauma

Question 5

Method of classification (2)

Answer 5

1 intra/extracapsular 2 displaced/undisplaced

Question 6

Classification of # distal to ITL?

Answer 6

Extracapsular

Question 7

with highest risk of AVN of femoral head?

Answer 7

Displaced intracapsular

Question 8

Blood supply to HoF? (3)

Answer 8

1 lateral circumflex 2 medial circumflex 3 intraosseus vessels and ligamentum teres artery

Question 9

What are subtrochanteric #s?

Answer 9

Fractures below level of lesser trochanter

Question 10

Usual aetiology of subtrochanteric #s?

Answer 10

Through region of pathological (metastatic) bone

Question 11

Common presentation in elderly? (2)

Answer 11

1 unable to weight bear 2 following fall

Question 12

Important medical causes of fall (3)

Answer 12

1 hypoglycaemia 2 orthostatic hypotension 3 arrhythmia

Question 13

Important information during clerking (3)

Answer 13

1 pre-injury level of function 2 home circumstances 3 comorbidities

Question 14

Appearance of displaced fracture? (2)

Answer 14

1 shortened 2 externally rotated

Question 15

Why check neurological status?

Answer 15

Nerve damage due to injury

Question 16

When is Thomas splint useful?

Answer 16

Subtrochanteric #

Question 17

Which imaging investigations?

Answer 17

Xray 1 AP pelvis 2 lateral affected

Question 18

Gold standard imaging for undisplaced, intracapsular compression #s?

Answer 18

MRI

Question 19

Are x-rays useful in undisplaced, intracapsular compression #s? (2)

Answer 19

1 No as 2 difficult to see

Question 20

Why are hip #s mobilised asap?

Answer 20

Reduces risks of long-term immobility

Question 21

Common risks of extended bed rest (3)

Answer 21

1 DVT 2 VTE 3 bed sores

Question 22

Treatment of undisplaced impacted intracapsular #s in elderly

Answer 22

1 analgaesia 2 early mobilisation

Question 23

Proportion of undisplaced impacted intracapsular hip # showing late displacement?

Answer 23

15%

Question 24

Treatment of intracapsular undisplaced #

Answer 24

DHS internal fixation

Question 25

Treatment of intracapsular displaced #

Answer 25

Hemiarthroplasty

Question 26

When is total arthroplasty appropriate? (3)

Answer 26

1 pre-existing athritis 2 few comorbidites and high functioning 3 in a displaced intracapsular #

Question 27

Treatment of intracapsular displaced # in young?

Answer 27

1 Reduction (open or closed) with 2 Fixation (internal or external)

Question 28

Treatment of extracapsular # (3)

Answer 28

1 Closed reduction 2 open fixation with 3 DHS

Question 29

When is an IMHS appropriate in extracapsular #s?

Answer 29

4 piece comminution

Question 30

Treatment of subtrochanteric and reverse obliquity #s?

Answer 30

stabilised with intramedullary nail

Question 31

Overall mortality in elderly at 90 days?

Answer 31

20%

Question 32

Complications of hip # surgery (4)

Answer 32

1 arthroplasty dislocation 2 non union 3 loss of fixation 4 lower limb thromboembolic disease