Fractured NOF

Question 1

What are the classic features of a hip fracture?

Answer 1

Pain (upper outer thigh or groin)
Leg shortened and externally rotated
Inability to bear weight

Question 2

Where is an intracapsular fracture?

Answer 2

From the edge of the femoral head to the insertion of the capsule of the hip joint

Question 3

Where is an extracapsular fracture?

Answer 3

Can either be trochanteric or subtrochanteric

Question 4

What is the Garden system?

Answer 4

Classification of hip fractures
Type I: Stable fracture but incomplete
Type II: Complete fracture but undisplaced
Type III: Displaced fracture (usually rotated and angulated)
Type IV: Complete boney disruption

Question 5

In what classification of NOF fractures would you be most likely to have a disruption of the blood supply?

Answer 5

Type III

Type IV

Question 6

What is the management for an intracapsular, undisplaced fracture?

Answer 6

internal fixation, or hemiarthroplasty if unfit

Question 7

What is the management for an intracapsular, displaced fracture?

Answer 7

young and fit and <70 = internal fixation and reduction

unfit = hemiarthroplasty or total hip replacement

Question 8

What is the management for an extracapsular fracture?

Answer 8

dynamic hip screw

if reverse oblique, transverse or subtrochanteric = intramedullary device

Question 9

What are the causes of hip fracture?

Answer 9

Minor trauma (fall, direct blow to side of the hip)
Osteoporosis
Metastatic disease 
Osteomalacia
Younger patients = high energy trauma

Question 10

How do you diagnose a hip fracture?

Answer 10

AP pelvic and lateral hip X-Rays

Disrupted Shenton’s line (formed by medial edge of femoral neck and inferior edge of superior pubic ramus)

Question 11

What is the prognosis following a hip fracture?

Answer 11

10% die within one month. A third die within 12 months.

Complications: infection, avascular necrosis, haemorrhage, pneumonia

Question 12

What is the NICE guideline on how to assess patient’s pain immediately after a hip fracture?

Answer 12

Assess pain immediately upon arrival at hospital, 30mins after administering initial analgesia and hourly until settled on the ward

Offer paracetamol every 6 hours preoperatively unless CI.
Offer additional opioids if paracetamol does not cover the pain.
Offer nerve blocks if opioids still do not cover the pain.

Question 13

What is the management of an extracapsular subtrochanteric fracture?

Answer 13

long intramedullary nail