Fracture Neck of Femur Flashcards
How are EPIPHYSEAL INJURIES classified?
- Salter-Harris classification
- Unique injuries to children
- 10% of all paediatric fractures
- Ligaments/capsules X2-5 stronger than epiphyses • Mostly wrist/ankle
- 75% aged 10-16
- Higher SH class - worse prognosis
What is a greenstick fracture?
Toddlers / younger children
Break in one cortex
Angulation, but unusual to get displacement
What is a Torus fracture?
TORUS - swelling/ bulging Longitudinal compression
How does a ‘Pulled Elbow’ in a child present?
- Under 5
- Pulled arm History (swinging)
- Hx – saved from fall/ traffic or swung
- Radial head is traumatically subluxated by forceful traction on the hand with the elbow extended and the forearm pronated
- annular ligament tears or slips over the radial head. Remains interposed between the radial head and capitellum
- No Xray Findings
- No Neurology
- Manipulation
How do SUPRACONDYLAR INJURIES present in ED?
• Most common elbow injury seen in A&E
• 4 - 10 years (younger patients get S-H I & II of distal
humerus)
• Fall on outstretched hand (FOOSH) - from a height
• Proximity of neurovascular structures makes them liable to immediate or delayed injury
• 5% vascular compromise
• 1% compartment syndrome
How is a Colle’s Fracture managed in ED?
- Haematoma Block
- Manipulation
- General Anaesthesia
- Fracture Clinic Follow up
What are the principles of management of fractured neck of femur in ED?
- Pathological Fracture • Elderly – Fall
- High 1 yr Mortality
- Fascia Iliaca Block
- Operative Management • Early Mobility
- Geriatric Review
What are the principles of management of fractured femur in ED?
- Long Bone – Fracture
- Trauma – High Impact
- Operative/Conservative Management • Blood Loss
- Thomas Splint
What is a Maisonneuve fracture?
Maisonneuve fracture refers to a combination of a fracture of the proximal fibula together with an unstable ankle injury (widening of the ankle mortise on x-ray), often comprising ligamentous injury (distal tibiofibular syndesmosis, deltoid ligament) and/or fracture of the medial malleolus. It is caused by pronation external-rotation mechanism.
this type of fracture pattern is generally managed by operative treatment.
Role of Ortho-geriatrician in fractured neck of femur
- Recognise concurrent illness
- Assess fitness for surgery
- Manage perioperative medical complications
- Falls assessment
- Bone health assessment
- Communicate with relatives (and the patient)
- Plan discharge and co-ordinate the MDT
Pre-operative assessment for elderly fractured neck of femur
- History of fall plus if there is any inter-current illness
- Review co-morbidities
- Review medications/drugs
- Functional level –physical and mental (consent)
- Consider levels of care/appropriate DNACPR decisions
- Review tests
- Communicate with patients and relatives
Elderly NOF: What sort of drugs might be relevant to surgery and falling?
- Clopidogrel, warfarin, NOAC
- Anti-hypertensives
- Nephrotoxic drugs
- Psychotropic medications
- Sedatives
- Alcohol
- Nicotine
Elderly NOF: Questions to ask for Functional level assessment
- House or flat? Sheltered accommodation?
- Nursing or residential home – makes a massive difference
- Can they wash/dress/eat independently?
- Package of care and frequency
- Do they do own shopping? If not who does?
- Do they leave the house? Aids? Manage stairs?
- Cognitive assessment
List components of Abbreviated Mental Test
- Age
- DOB
- Year
- Place
- Time (nearest hour)
- Recall
- Recognition (2 person)
- WW1 (year)
- Monarch
- 20 to 1
What is the Nottingham hip fracture score?
30 day mortality based on number of points on scale.
0 to 10 points ranges from 0.7 to 45%
Variables include: Age 65-85 or Age >85 Sex AMTS Admission Hb < 100 Residence in an institution Co-morbidities >1 Malignancy <20yrs (not BCC/SCC)
