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Final Notes > FN: Hip Fracture > Flashcards

FN: Hip Fracture Flashcards

1
Q

Epi

A

80/100,000
50% in >80 yrs
F>M = 3:1

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2
Q

Epi

A

80/100,000
50% in >80 yrs
F>M = 3:1

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3
Q

Pathophysiology

A 
Old = osteoporosis with minor trauma (e.g. fall)
Young = major trauma
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4
Q

Osteoporosis risk factors: Age + SHATTERED

A

Steroids
Hyper-para/thyroidism
Alcohol and Cigarettes
Thin (BMI

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5
Q

Presnetation O/E

A 
Shortened and externaly rotated
Key Q's:
1. Mechanims
2. RF for osteoporosis/pathological fractures
3. Premorbid mobility
4. Premorbid independence
5. Cormorbidities
6. MMSE
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6
Q

Initial Management

A
  • Resuscitate: dehydration, hypothermia
  • Analgesia M+M
  • Assess: AP and lateral films
  • Prep for theatre
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7
Q

Prepping for theatre

A 
Inform Aneasthetist and book theatre
Bloods: FBC, U+E, clotting, X-match (2u)
CXR
DVT prophylaxis: TEDS, LMWH
ECG
Films: orthogonal X-rays
Get consent
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8
Q

Imaging

A 
Ap and latweral fimls
Look @ Shentons lines
Intra or extra capsular
Displaced or nondisplaced
Osteopaenic
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9
Q

Key Anatomy

A
  1. Capsule attaches proximally to acetabular margin and distaly to intertrochanteric line
  2. Blood supply to femoral head
    - Retinacular vessels, incapsule, distal - proximal
    - Intramedullary vessels
    - Artery of ligamentum teres
  3. If retinacular vessels damaged there is risk of AVN of the femoral head - pain, stiffness and OA
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10
Q

Classification

A

Intracapsular: subcapital, transcervical, basicervical

Extracapsular: Intertrochanteric, subtrochanteric

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11
Q

Classification

A

Garden classification

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12
Q

Garden Classification of intracapsular Fractures

A
  1. Incomplete fractures undisplaced
  2. Complete fractures undisplaced
  3. Complete fracture partially displaced
  4. Complete fracture completely displaced
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13
Q

Surgical Management Intracapsular 1,2

A

1,2: ORIF with cancellous screws

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14
Q

Intracapsular Mx 3,4:

A
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15
Q

Pathophysiology

A 
Old = osteoporosis with minor trauma (e.g. fall)
Young = major trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Osteoporosis risk factors: Age + SHATTERED

A

Steroids
Hyper-para/thyroidism
Alcohol and Cigarettes
Thin (BMI

17
Q

Presnetation O/E

A 
Shortened and externaly rotated
Key Q's:
1. Mechanims
2. RF for osteoporosis/pathological fractures
3. Premorbid mobility
4. Premorbid independence
5. Cormorbidities
6. MMSE
18
Q

Initial Management

A
  • Resuscitate: dehydration, hypothermia
  • Analgesia M+M
  • Assess: AP and lateral films
  • Prep for theatre
19
Q

Prepping for theatre

A 
Inform Aneasthetist and book theatre
Bloods: FBC, U+E, clotting, X-match (2u)
CXR
DVT prophylaxis: TEDS, LMWH
ECG
Films: orthogonal X-rays
Get consent
20
Q

Imaging

A 
Ap and latweral fimls
Look @ Shentons lines
Intra or extra capsular
Displaced or nondisplaced
Osteopaenic
21
Q

Key Anatomy

A
  1. Capsule attaches proximally to acetabular margin and distaly to intertrochanteric line
  2. Blood supply to femoral head
    - Retinacular vessels, incapsule, distal - proximal
    - Intramedullary vessels
    - Artery of ligamentum teres
  3. If retinacular vessels damaged there is risk of AVN of the femoral head - pain, stiffness and OA
22
Q

Classification

A

Intracapsular: subcapital, transcervical, basicervical

Extracapsular: Intertrochanteric, subtrochanteric

23
Q

Classification

A

Garden classification

24
Q

Garden Classification of intracapsular Fractures

A
  1. Incomplete fractures undisplaced
  2. Complete fractures undisplaced
  3. Complete fracture partially displaced
  4. Complete fracture completely displaced
25
Q

Surgical Management Intracapsular 1,2

A

1,2: ORIF with cancellous screws

26
Q

Intracapsular Mx 3,4:

A

75: hemiarthroplasty
- mobilses = cemented thompsons
- non-mobilser: cemented Austin Moore

27
Q

Extracapsular Mx

A

ORIF with DHS

28
Q

Discharge invovles

A

OT and Physios

Discharge when mobilsation and social circumstances permit

29
Q

Specific complications

A

AVN of femoral head in displaced fractures (30%)
Non/mal-union (10-30%)
Infection
Osteoarthritis

30
Q

Prognosis

A

30% mortality @ 1ye
50% never regain pre=borbid functioning
>10% unable to return to premorbid residence
Majority will have some residual pain or disability

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