Fractured Hip - 218

Question 1

What are the 2 broad classifications of NOF fractures?

Answer 1

Intracapsular and extracapsular

Question 2

Describe the blood supply to the femoral head

Answer 2

Medial and lateral circumflex femoral arteries

Question 3

Garden’s classification describes what kind of fracture?

Answer 3

NOF

Question 4

What are the surgical options for a NOF fracture?

Answer 4

DHS, cannulated screw, hemiarthroplasty, total hip

Question 5

What kind of fracture would you use a dynamic hip screw for?

Answer 5

An intracapsular NOF fracture

Question 6

What balance does bone health depend on?

Answer 6

Bone resorption and bone formation

Question 7

Describe the pathology behind osteoporosis

Answer 7

Low bone mass, deterioration of bone tissue and increased bone fragility -> due to bone resorption being greater than bone formation

Question 8

What are the risk factors for osteoporosis?

Answer 8

Age, female, genetics, oestrogen deficiency, hypogonadism, smoking, alcohol, low BMI

Question 9

What investigations would you do if you suspected osteoporosis in a patient?

Answer 9

• Measure bone mineral density by a DEXA scan
• Blood tests (should be normal in OP)
  FRAX score for OP risk assessment

Question 10

You suspect a lady has osteoporosis, what are you first treatment steps going to be?

Answer 10

• Calcium and vitamin D supplememts
• Recommend exercise
• Modify risk factors
• Falls prevention
• Awareness

Question 11

How do bisphosphonates treat OP?

Answer 11

They decrease bone resorption by inhibiting osteoclasts. They are usually given with Vit D

Question 12

What is the most common bisphosphonate given for OP? What is a rare but severe side effect?

Answer 12

Alendronate

Osteonecrosis of the jaw, atypical femoral #

Question 13

Denosumab, a RANKL inhibitor, is used for what?

Answer 13

Osteoporosis, it prevents osteoclast survival.

Question 14

What drug for OP increases bone formation?

Answer 14

Teriparatide, recombinant PTH

Question 15

What is osteomalacia?

Answer 15

Vitamin D deficiency in adults

Question 16

What is rickets?

Answer 16

Vitamin D deficiency in children

Question 17

In a patient with vitamin D deficiency, what are the PTH levels like?

Answer 17

High

Question 18

Describe the bone structure in Paget’s Disease

Answer 18

Woven, weaker than normal

Question 19

What is the pathology in Paget’s disease?

Answer 19

Osteoclast over activity resulting in lots of woven bone, which is weaker than normal. Results in bone pain, worse on weight bearing, increased CO.

Question 20

How is paget’s disease diagnosed?

Answer 20

Bloods, x-ray, increased Alk Phos

Question 21

What are the 4 stages to fracture healing?

Answer 21

1) Inflammation - pain, hematoma
2) Soft callus - bony fragments united by fibrous tissue
3) Hard callus - mineralisation of cartilage, woven bone
4) Remodelling - woven bone converts to lamellar

Question 22

What is the triad of symptoms that make you consider a fat embolism after a long bone trauma?

Answer 22

Resp.
Neuro.
Petechial rash

Question 23

What cancers can metastasise to bone?

Answer 23

Breast, prostate, bronchus, kidney, thyroid