Fractured NOF Flashcards
What are the causes of NOF fractures?
Low energy trauma (falling from standing height)
Other causes:
- high energy trauma
- pathological fractures (tumour or infection related)
- reduced BMD (osteopenia, osteoporosis)
- stress fractures (less common)
Describe intracapsular fractures (in terms of anatomical locations).
- Proximal to the intertrochanteric line
- blood supply from femoral circumflex arteries and nutrient arteries inside the bone are disrupted
- High risk of avascular necrosis
Describe extracapsular fractures (in terms of anatomical locations).
- Below the intertrochanteric line
- Typically include intertrochanteric and subtrochanteric fractures
What is Garden classification? Describe each stage.
- Classifies fractures according to the degree of displacement seen on an AP radiograph
- Stage 1: incomplete fracture line or impacted fracture
- Stage 2: complete fracture line, non-displaced
- Stage 3: complete fracture line, partial displacement
- Stage 4: complete fracture line, complete displacement
What is Pauwels classification? Describe each stage.
- Classifies fractures according to the angle of the fracture line from horizontal
- Type 1: 0-30 degrees
- Type 2: 30-50 degrees
- Type 3: >50 degrees
What are the risk factors for NOF fractures?
- ≥65 years in women and ≥75 years in men
- Hx: menopause, amenorrhoea, smoking, excessive alcohol or caffeine intake, physical inactivity, long-term or high-dose corticosteroid use
- Previous fragility fracture
- Hx of falls
- Poor nutrition
- Low BMI
- Dementia
- Visual impairment
- Hx of tumours
What investigations should be performed as part of work-up for NOF fractures?
- ECG (arrhythmias and coronary events)
- Baseline bloods: FBC, U&E, coagulation screen
- Creatinine kinase (rhabdomyolysis)
- Urinalysis
- G&S
- X-ray pelvis and lateral hip (AP)
- MRI
Which investigation is the gold standard to exclude a hip fracture?
MRI
Describe the initial management of NOF fractures.
- Analgesia
- IV access (for fluid resus, blood transfusion, medication administration)
Describe the surgical management of intracapsular fractures.
Younger patient (<65):
- Cannulated screws
- Dynamic hip screw
Older patients (≥65):
- Total hip replacement
- Hemiarthroplasty
Describe the surgical management of extracapsular fractures.
- Internal fixation favourable with DHS or trochanteric femoral intramedullary nailing
What are the indications for non-operative management of NOF fractures?
- Patient too unwell
- Short life expectancy
- Delayed presentation or diagnosis of fracture with signs of healing
- Immobile patients
- Patients who decline surgery
Describe the post-operative management of NOF fractures.
- Mobilisation ASAP + rehabilitation
- analgesia
- falls risk assessment
- dietetic assessment
- early mobilisation
- axial bone densitometry
- abx prophylaxis
- thromboembolism prophylaxis
What are the complications of non-operative conservative management of NOF fractures?
- Fracture displacement
- Non-union or mal union
- Avascular necrosis of femoral head
- Venous thromboembolism
- Pressure sores
- Infection: pneumonia and urinary tract infections
- Death
What are the medical complications following operative management of NOF fractures?
- Surgical site infection
- Protein-caloric malnutrition (20-70%)
- Anaemia (24%-44%)
- Venous thromboembolism (27%/1-7%)
- Post-operative delirium (13% to 33%)
- Bleeding
- Fat embolism
