Fractures Flashcards
What are risk factors for hip fractures?
Older (90% 60+) Young adults with high energy trauma Female Smoker Malnutrition Excess alcohol Neurological impairment Impaired vision Low BMI
What are the bony features of the proximal femur?
Head
Neck
Greater trochanter
Lesser trochanter
What is classed as an intra and extra-capsular hip fracture?
Intra - the neck and head of femur
Extra - distal to the neck (including greater and lesser trochanter)
Where does the blood supply to the femoral head come from?
Intra-medullary artery of shaft of femur
Medial and lateral circumflex branches of profunda femoris
Artery of ligamentum teres
Which arteries’ blood supply is are cut off in an intra-capsular hip fracture, and which are still intact?
Cut off:
- Medial and lateral circumflex branches of profunda femoris
- Intramedullary artery of shaft of femur
Intact:
- Ligamentum teres
Which arteries’ blood supply is are cut off in an extra-capsular hip fracture, and which are still intact?
Cut off:
- Intramedullary artery of shaft of femur
Intact:
- Medial and lateral circumflex branches of the profunda femoris
- Ligamentum teres
Which type of proximal femur (hip) fracture is more serious, and why?
Intracapsular
Blood supply is cut off - risk of avascular necrosis
What are the different grades of intracapsular hip fractures?
Grade 1 - split in surface of neck
Grade 2 - complete break of the neck
Grade 3 - partial displacement of head and neck
Grade 4 - complete displacement of head and neck
What are the different types of intra-capsular hip fractures, based on anatomical position of the fracture?
Subcapital - just underneath the head of femur
Transcervical - fracture along middle of neck
What are the different types of extra-capsular hip fractures, based on anatomical position of the fracture?
Basicervical - just under the neck
Intertrochanteric - fracture from the greater to lesser trochanter
Subtrochanteric - under both trochanters
When taking history of a hip fracture, what information do you need to know about the injury?
Mechanism (mechanical fall or secondary to other cause)
Corroborated history from family member if possible if patient is confused
When taking history of a hip fracture, what information do you need to know about the past medical history?
Relevant conditions e.g. Diabetes Bleeding disorders CVD Parkinson's
When taking history of a hip fracture, what information do you need to know about the drug history?
Medications
Anticoagulation status
Medication changes
When taking history of a hip fracture, what information do you need to know about the social history?
Patient’s usual function
Walking aids?
Carers?
Lives in own home?
What needs to be done when examining a patient with hip fracture?
Able to weight bear? Cognitive impairment? Look for missed injuries Fluid status/dehydration Neurovascular status Leg usually shortened and externally rotated
What tests can be initially done for a patient with a hip fracture?
ECG
Bloods
What imaging should be done for a hip fracture?
X-ray of pelvis and lateral hip
CXR if pre-existing lung disease
If in doubt - MRI
What imaging sign can give a good indication of whether hip fracture is present?
Loss of Shenton’s line
can still be normal though
What is the management for an intra-capsular hip fracture in a high functioning patient?
If displaced - THR
If undisplayed - compression hip screw (CHS)
What is the management for an intra-capsular hip fracture in a low functioning patient?
Hemi-arthroplasty
What is a hemi-arthroplasty?
Partial hip replacement - just ball and socket part
What is the management for an extra-capsular, inter-trochanteric hip fracture?
Dynamic Hip Screw (DHS)
What is the management for an extra-capsular, sub-trochanteric hip fracture?
Intra-medullary (IM) nail
What are the complications of intra-capsular hip fractures?
Non-union Avascular necrosis Loss of function Infection Medical risk (DVT, PE, MI, CVA) Dislocation Periprosthetic fracture
