H I P

Question 1

what are the anatomical classifications of NOF fractures?

Answer 1

• intra-capsular- between the head and the neck
• extra-capsular - divided into inter-trochanetric (between greater and lesser trochanter) and sub-trochanteric (5cm distal from the lesser trochanter)

Question 2

describe the blood supply to the NOF

Answer 2

• retrograde blood supply (from distal to proximal)

- mainly through the medial circumflex femoral artery which lies in intra-capsular femoral neck

Question 3

displaced intracapsular NOF fracture risk

Answer 3

displaced intra-capsular NOF fractures disrupt blood supply to femoral head and cause AVN even if hip is fixed

• so patients require athroplasty (joint replacement) rather than fixation

Question 4

how are intra-capsular fractures classified

Answer 4

• garden classification (I-IV)
• I-II = non-displaced, incomplete vs complete fracture
• III-IV = displaced, complete fracture + partial displaced vs. complete fracture + fully displaced

Question 5

what are the clinical features of pt with NOF features

Answer 5

• trauma (low energy)
• pain in groin, thigh or referred to knee
• inability to weight bear

Question 6

what are the features seen on NOF on examination

Answer 6

• leg is shortened and externally rotated (due to pull of external rotators
• pain on pin-rolling leg and axial loading
• N+V deficits are rare

Question 7

ddx for NOF

Answer 7

• acetabular fracture

- femoral head fracture

Question 8

What lx required in NOF

Answer 8

• urine
• CXR, ECG - pre op assessment and peri-operative assessment especially in elderly patients
• bloods: routine bloods including: FBC, UE, coag screen, group and save, CK (assess for rhabdomyolysis)

Question 9

How are NOF fractures managed

Answer 9

1. A-E approach
2. analgesia and anti-emetics
3. surgical management
4. post op NOF patients should be managed jointly under the care of theortho-geriatricians- best outcomes achieved viaearly rehabilitation
   throughphysiotherapists
   andoccupational therapists.

image for producer for each fracture

Question 10

what are the immediate post op complicated in NOF

Answer 10

pain, bleeding, leg-length discrepancies, and potential neurovascular damage

Question 11

what are the complications of NOF fractures

Answer 11

• joint dislocation, aseptic loosening, deep infection or prosthetic joint infection
• AVN in intra-capsular NOF fractures
• mortality rate is 30% for NOF fractures

Question 12

management of displaced subcapital

Answer 12

hip hemiarthroplasty

Question 13

inter trochanter and basocervical management

Answer 13

DHS

Question 14

non displaced intra capsular

Answer 14

cannulated hip screws

Question 15

sub trochanteric

Answer 15

IM