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Year Two - Musculoskeletal System > Fractured Neck of Femur > Flashcards

Fractured Neck of Femur Flashcards

1
Q

What is fractured neck of femur (FNOF)?

A

It is defined as a fracture involving the neck region of the femur bone

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2
Q

What are the three classification sytems of fractured neck of femurs?

A

Anatomical Classification System

Garden Classification System

Pauwels Classification System

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3
Q

What is the anatomical classification system of fractured neck of femurs?

A

It classifies fractured neck of femur according to the location of the fracture within the femoral neck

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4
Q

What are the two anatomical classifications of fractured neck of femurs?

A

Intracapsular Fractured Neck of Femur

Extracapsular Fractured Neck of Femur

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5
Q

What is another term for intracapsular fractured neck of femurs?

A

Subcapital

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6
Q

What are intracapsular fractured neck of femurs?

A

It is defined as a fracture which occurs proximal to the intertrochanteric line

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7
Q

What is the pathophysiological consequnce of intracapsular fractured neck of femurs?

A

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

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8
Q

What is another term for extracapsular fractured neck of femurs?

A

Intertrochanteric

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9
Q

What are extracapsular fractured neck of femurs?

A

It is defined as a fracture which occurs below the intertrochanteric line

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10
Q

What is the pathophysiological consequence of extracapsular fractured neck of femurs?

A

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

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11
Q

What is the Garden classification system of fractured neck of femurs?

A

It classifies fractured neck of femurs according to the degree of displacement visualised on AP radiograph

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12
Q

What is garden stage one fractured neck of femur?

A

It is defined as a stable, incomplete fracture, in which there is impaction in valgus

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13
Q

What is garden stage two fractured neck of femur?

A

It is defined as a complete fracture, which is undisplaced

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14
Q

What is garden stage three fractured neck of femur?

A

It is defined as a complete fracture, in which there is partial displacement – usually rotated and angulated, however still has bony contact

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15
Q

What is garden stage four fractured neck of femur?

A

It is defined as a complete fracture, in which there is complete displacement

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16
Q

What is Pauwels classifcation system of fractured neck of femurs?

A

It classifies fractured neck of femurs according to the angle of the fracture line from horizontal

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17
Q

What is Pauwels stage I fractured neck of femur?

A

It is defined as a fracture angle between 0 and 30 degrees

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18
Q

What is Pauwels stage II fractured neck of femur?

A

It is defined as a fracture angle between 30 and 50 degrees

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19
Q

What is Pauwels stage III fractured neck of femur?

A

It is defined as a fracture angle greater than 50 degrees

20
Q

What are nine risk factors associated with fractured neck of femurs?

A

Older Age > 65 Years Old

Female Gender

Fragility Fracture History

Falls History

Osteoporosis

Dementia

Visual Impairment

Poor Nutrition

Low BMI < 18.5

21
Q

What are the five clinical features of fractured neck of femurs?

A

Hip Pain

Weight Bearing Inability

Reduced Hip Movement

Short, Externally Rotated Leg

Positive Log Roll Sign

22
Q

What is a positive log roll sign?

A

It is stimulation of hip pain on gentle internal and external rotation of the affected leg

23
Q

What two investigations are used to diagnose fractured neck of femurs?

A

Hip X-Ray

MRI Scans

24
Q

When are hip x-rays used to manage fractured neck of femurs?

A

They are the first line investigation

25
Q

What are the five features of fractured neck of femur on hip x-rays?

A

Flexed & Externally Rotated Femur

Femoral Neck Smudgy Sclerosis

Prominent Lesser Trochanter

Angulated Bone Trabeculae

Shenton’s Line

26
Q

What is Shenton’s line?

A

It is a loss of contour between normally continuous line from medial edge of femoral neck and inferior edge of the superior pubic ramus

27
Q

What is the gold standard investigation used to diagnose fractured neck of femur?

A

MRI scans

28
Q

What are the four features of fractured neck of femur on MRI scans?

A

Flexed & Externally Rotated Femur

Femoral Neck Sclerosis

Prominent Lesser Trochanter

Angulated Bone Trabeculae

29
Q

What is the most appropriate management step in suspected fractured neck of femurs?

A

We refer for orthogeriatric assessment within 72 hours

30
Q

When is non-surgical management of fractured neck of femurs recommended?

A

It is used to manage individuals who are unfit for surgical management

31
Q

What are the three non-surgical management options of fractured neck of femurs?

A

Casts

Splints

Traction

32
Q

When should surgical management of fractured neck of femurs be conducted?

A

Within 36 hours of admission

33
Q

What analgesia is recommended in fractured neck of femurs?

A

Iliofascial nerve block

34
Q

What are the two surgical management options of intracapsular fractures?

A

Internal Fixation

Hip Arthroplasty

35
Q

When is internal fixation used to manage intracapsular fractured neck of femurs?

A

It is used to manage undisplaced intracapsular fractured neck of femurs in physiologically fit individuals

36
Q

What is internal fixation?

A

It involves repositioning of the bone fragments, which are then held together with special implants – including dynamic hip screws, cannulated screws or intramedullar devices

37
Q

What two internal fixation implants are used in intracapsular fractured neck of femurs?

A

Dynamic hip screws

Cannulated screws

38
Q

What are dynamic hip screws?

A

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

39
Q

What are cannulated screws?

A

They refer to a set of plates being driven into the femoral head across the fracture

40
Q

When is hip arthroplasty used to manage intracapsular fractured neck of femurs?

A

It is used to manage displaced intracapsular fractured neck of femurs

OR

It is undisplaced intracapsular fractured neck of femurs in physiologically unfit individuals

41
Q

In which three circumstances is total hip arthroplasty used to manage intracapsular fractured neck of femurs?

A

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

42
Q

What is hip arthroplasty?

A

It involves removal of damaged bone and cartilage and replacement with metal/plastic joint surface in order to restore joint function

43
Q

What is the surgical management option of extracapsular fractured neck of femurs?

A

Internal Fixation

44
Q

What are the two internal fixation implants used in extracapsular fractured neck of femurs?

A

Dynamic hip screws

Intramedullary devices

45
Q

When are dynamic hip screws used to manage extracapsular fractured neck of femurs?

A

Stable proximal extracapsular fractures

46
Q

When are intramedullary devices used to manage extracapsular fractured neck of femurs?

A

Reverse oblique, transverse or subtrochanteric extracapsular fractures

47
Q

What advice should be given to individuals about weight bearing following fractured neck of femur surgery? Why?

A

All individuals should fully weight bear immediately post-op

This is to prevent post-operative complications, including venous thromboembolism, pressure ulcers, bronchopneumonia, etc

Year Two - Musculoskeletal System (15 decks)

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