Fractures of the Hip and Proximal Femur

Question 1

Fractures of the proximal femur are more common in which sex?

Answer 1

Females

(mainly due to higher levels of osteoporosis)

Question 2

Fractures of the proximal femur are common in young people associated in ________ _________ accidents

Answer 2

High energy

Question 3

Risk factors for proximal femoral fractures include what?

Answer 3

1. Age
2. Osteoporosis
3. Smoking
4. Malnutrition
5. Alcohol
6. Neurological impairment
7. Impaired vision

Question 4

Which vessels supply the femoral head?

Answer 4

1. Intramedullary artery
2. Medial and lateral circumflex braches of profunda femoris
3. Vessel of ligamentum teres

Question 5

What are the two categories of proximal femoral fractures?

Answer 5

1. Intracapsular
2. Extracapsular

Question 6

What is the danger of intracapsular fractures of the femur?

Answer 6

The blood vessels may not be intact and blood supply may be lost to the femoral head

Question 7

Whar are the two main types of intracapsular proximal femoral fractures?

Answer 7

1. Undisplaced
2. Displaced

Question 8

The Garden classification system describes which types of fractures?

Answer 8

Intracapsular femoral fractures

Question 9

What is a Garden type 1 fracture?

Answer 9

An incomplete, stable fracture with impactation in valgus

Question 10

What is a Garden type 2 fracture?

Answer 10

A complete but not displaced fracture with no disturbance of the medial trabecular lines

Question 11

What is a Garden type 3 fracture?

Answer 11

A completely displaced fracture with varus and all 3 trabecullae disturbed

Question 12

What is a Garden type 4 fracture?

Answer 12

A completely displaced fracture that is completely displaced

(the femoral head is aligned correctly in the acetabulum)

Question 13

What are the three types of extracapsular fractures?

Answer 13

1. Basicervical fractures
2. Intertrochanteric fractures
3. Subtrochanteric fractures

Question 14

What are the two main complications of intracapsular femoral fractures?

Answer 14

1. AVN
2. Non-union

Question 15

What are the two main complications of extracapsular femoral fractures?

Answer 15

1. Malunion
2. Non-union

Question 16

With fractures involving the proximal femur, which X-ray sign is indicative of a fracture?

Answer 16

Shenton’s line

(it is a broken curve in fracture)

Question 17

What is essential in dertermining whether a fracture is intra or extracapsular?

Answer 17

Lateral X-ray

(ALWAYS ask for one)

Question 18

Which investigations are most utiliased for a proximal femoral fracture?

Answer 18

1. X-ray (AP and lateral)
2. MRI

Question 19

If an intracapsular femoral fracture is undisplaced what is the treatment?

Answer 19

Fix the fracture and leave the femoral head

Nail

Dynamic hip screw and plate

Question 20

If a patient is old and has a intracapsular femoral fracture which is displaced, what is the treatment?

Answer 20

Hip replacement

(or hemiarthroplasty for low demand patients)

Question 21

Is a patient is young and they have a displaced proximal femoral fracture that is intracapsular, what is the treatment?

Answer 21

Fix the fracture and leave the femoral head#

Nail

Dynamic hip screw and plate

(this does no always work, but is worth trying due to patient age and likelihood of success)

Question 22

Extracapsular femoral fractures, for the most part, always ______

Answer 22

Heal

(a dynamic hip screw can be used)