Fractured Neck of Femur Flashcards
What is fractured neck of femur (FNOF)?
It is defined as a fracture involving the neck region of the femur bone
What are the three classification sytems of fractured neck of femurs?
Anatomical Classification System
Garden Classification System
Pauwels Classification System
What is the anatomical classification system of fractured neck of femurs?
It classifies fractured neck of femur according to the location of the fracture within the femoral neck
What are the two anatomical classifications of fractured neck of femurs?
Intracapsular Fractured Neck of Femur
Extracapsular Fractured Neck of Femur
What is another term for intracapsular fractured neck of femurs?
Subcapital
What are intracapsular fractured neck of femurs?
It is defined as a fracture which occurs proximal to the intertrochanteric line
What is the pathophysiological consequnce of intracapsular fractured neck of femurs?
It involves damage to the joint capsule, which results in disruption of the blood supply from the femoral circumflex arteries and nutrient arteries
Therefore, there is a high risk of avascular necrosis of the femoral head and non-union of the fracture
What is another term for extracapsular fractured neck of femurs?
Intertrochanteric
What are extracapsular fractured neck of femurs?
It is defined as a fracture which occurs below the intertrochanteric line
What is the pathophysiological consequence of extracapsular fractured neck of femurs?
There is no damage to the joint capsule, and therefore the blood supply to the fracture site is sufficient – leading to improved fracture healing and a good prognosis
What is the Garden classification system of fractured neck of femurs?
It classifies fractured neck of femurs according to the degree of displacement visualised on AP radiograph
What is garden stage one fractured neck of femur?
It is defined as a stable, incomplete fracture, in which there is impaction in valgus
What is garden stage two fractured neck of femur?
It is defined as a complete fracture, which is undisplaced
What is garden stage three fractured neck of femur?
It is defined as a complete fracture, in which there is partial displacement – usually rotated and angulated, however still has bony contact
What is garden stage four fractured neck of femur?
It is defined as a complete fracture, in which there is complete displacement
What is Pauwels classifcation system of fractured neck of femurs?
It classifies fractured neck of femurs according to the angle of the fracture line from horizontal
What is Pauwels stage I fractured neck of femur?
It is defined as a fracture angle between 0 and 30 degrees
What is Pauwels stage II fractured neck of femur?
It is defined as a fracture angle between 30 and 50 degrees
What is Pauwels stage III fractured neck of femur?
It is defined as a fracture angle greater than 50 degrees
What are nine risk factors associated with fractured neck of femurs?
Older Age > 65 Years Old
Female Gender
Fragility Fracture History
Falls History
Osteoporosis
Dementia
Visual Impairment
Poor Nutrition
Low BMI < 18.5
What are the five clinical features of fractured neck of femurs?
Hip Pain
Weight Bearing Inability
Reduced Hip Movement
Short, Externally Rotated Leg
Positive Log Roll Sign
What is a positive log roll sign?
It is stimulation of hip pain on gentle internal and external rotation of the affected leg
What two investigations are used to diagnose fractured neck of femurs?
Hip X-Ray
MRI Scans
When are hip x-rays used to manage fractured neck of femurs?
They are the first line investigation
What are the five features of fractured neck of femur on hip x-rays?
Flexed & Externally Rotated Femur
Femoral Neck Smudgy Sclerosis
Prominent Lesser Trochanter
Angulated Bone Trabeculae
Shenton’s Line
What is Shenton’s line?
It is a loss of contour between normally continuous line from medial edge of femoral neck and inferior edge of the superior pubic ramus
What is the gold standard investigation used to diagnose fractured neck of femur?
MRI scans
What are the four features of fractured neck of femur on MRI scans?
Flexed & Externally Rotated Femur
Femoral Neck Sclerosis
Prominent Lesser Trochanter
Angulated Bone Trabeculae
What is the most appropriate management step in suspected fractured neck of femurs?
We refer for orthogeriatric assessment within 72 hours
When is non-surgical management of fractured neck of femurs recommended?
It is used to manage individuals who are unfit for surgical management
What are the three non-surgical management options of fractured neck of femurs?
Casts
Splints
Traction
When should surgical management of fractured neck of femurs be conducted?
Within 36 hours of admission
What analgesia is recommended in fractured neck of femurs?
Iliofascial nerve block
What are the two surgical management options of intracapsular fractures?
Internal Fixation
Hip Arthroplasty
When is internal fixation used to manage intracapsular fractured neck of femurs?
It is used to manage undisplaced intracapsular fractured neck of femurs in physiologically fit individuals
What is internal fixation?
It involves repositioning of the bone fragments, which are then held together with special implants – including dynamic hip screws, cannulated screws or intramedullar devices
What two internal fixation implants are used in intracapsular fractured neck of femurs?
Dynamic hip screws
Cannulated screws
What are dynamic hip screws?
They refer to a flexible plate which is positioned across the fracture line into the femoral head
It enables organised collapse of the fractures when the patient weight-bears, which improves fracture healing and union
What are cannulated screws?
They refer to a set of plates being driven into the femoral head across the fracture
When is hip arthroplasty used to manage intracapsular fractured neck of femurs?
It is used to manage displaced intracapsular fractured neck of femurs
OR
It is undisplaced intracapsular fractured neck of femurs in physiologically unfit individuals
In which three circumstances is total hip arthroplasty used to manage intracapsular fractured neck of femurs?
It is recommended to manage individuals who were able to walk independently with no more than use of stick, who are not cognitively impaired and are medically fit for surgery
What is hip arthroplasty?
It involves removal of damaged bone and cartilage and replacement with metal/plastic joint surface in order to restore joint function
What is the surgical management option of extracapsular fractured neck of femurs?
Internal Fixation
What are the two internal fixation implants used in extracapsular fractured neck of femurs?
Dynamic hip screws
Intramedullary devices
When are dynamic hip screws used to manage extracapsular fractured neck of femurs?
Stable proximal extracapsular fractures
When are intramedullary devices used to manage extracapsular fractured neck of femurs?
Reverse oblique, transverse or subtrochanteric extracapsular fractures
What advice should be given to individuals about weight bearing following fractured neck of femur surgery? Why?
All individuals should fully weight bear immediately post-op
This is to prevent post-operative complications, including venous thromboembolism, pressure ulcers, bronchopneumonia, etc
