fractured neck of femur

Question 1

what classification is used for grading intra-capsular femoral head fractures

Answer 1

Garden classification

1-2 are undisplaced
3-4 are displaced (complete)

Question 2

which type of femoral head fractures can compromise the retinacular vessels ?

Answer 2

intra-capsular

compromised retinacular vessels leads to avascular necrosis

Question 3

mx of intra-capsular fractures

Answer 3

undisplaced = ORIF and cancellous screws

Question 3

mx of intra-capsular fractures

Answer 3

undisplaced = ORIF and cancellous screws

displaced = varies dependent on age and in practice

generally <55yrs = ORIF and cancellous screws , from this 30% will develop avascular necrosis and require arthroplasty

> 75yrs will undergo hemi-arthroplasty

> ages in-between this = total hip replacement is preferred

Question 4

what is orif

Answer 4

open reduction and internal fixation is a type of surgery used to stabilise (put bone back into place) and heal a broken bone

it is a major surgery

Question 5

what is avascular necrosis

Answer 5

death of bone tissue due to lack of blood supply

Question 6

mx of extra-capsular fractures

Answer 6

ORIF with a dynamic hip screw replacement

Question 7

what prosthesis is this

Answer 7

dynamic hip screw

is it a large screw that runs from under the greater trochanter through the neck of femur and into the head

this is then attached to a plate which is screwed into the proximal femoral shaft

Question 8

T/F dynamic hip screw is common for extra-capsular hip fractures

Answer 8

T

they are designed to push the extracapsular fracture fragments together during weight bearing

Question 9

buzzword - shortened and externally rotated leg

Answer 9

hip fracture !

Question 10

A 88-year old lady is brought to the emergency department after sustaining a fall in her nursing home. On arrival, she complains of severe pain in her groin and is unable to weight bear. She has a past medical history of osteoporosis and COPD.

On examination, she is in a lot of pain but her observations are stable. Her left hip is tender to palpation and with some ecchymoses over the greater trochanter, but there are no breaks in the skin. The left leg is shortened and externally rotated.

Which of the following would be the best investigation to do first?

Answer 10

pelvic and left hip lateral radiographs