Hip Flashcards
what are the 2 main different types of NOF fractures
intracapsular or extracapsular (intertrochanteric and subtrochanteric)
describe the blood supply of the femoral head and what arteries are responsible (in adults and children)
blood supply is retrograde (goes from distal to proximal) - through the medial circumflex femoral artery
in children blood supply is via ligamentum arteriosum that lies within the ligamentum teres but this dramatically reduces in size and is of no importance in adults
intracapsular NOF fractures are classified using what system - and describe it
garden classification system
organised into displaced vs non-displaced and then partial or full displacement
on examination, how does a NOF fracture present
affected leg is characteristically shortened and externally rotated
investigations into NOF fractures
plain film radiograph - AP and lateral
routine bloods, FBC, U&Es, group and save
creatinine kinase if suspecting a long lie and rhabdo
urine dip, CXR and ECG all useful in complete assessment of elderly and pre-op assessment aswell
different types of surgical management of a NOF fracture
hip hemiarthroplasty and total arthroplasty
dynamic hip screws
intermedullary nails
when would you consider a hemi vs total hip arthroplasty
consider total hip arthroplasty in patients who were systemically well and living independently prior to injury
what would be the most appropriate surgical intervention for a subtrochanteric femoral fracture
intramedullary femoral nail
what are distal femur fractures classified into
extra-articular (type A)
partial articular (type B)
complete articular (type C)
what is a Hoffa fracture
particular type of type B distal femoral fracture where there is a fracture of the posterior aspect of the femoral condyles in the coronal plane
management of distal femur fractures
resus and stabilisation as per ATLS guidelines
initial realignment and then immobilisation using skin traction
then definitive management involves retrograde nailing or ORIF
what artery/branches supply blood to the femur
penetrating branches of the profunda femoris artery
why can large volumes of blood be lost in femoral shaft fractures
highly vascularised bone due to its role in haematopoiesis
large volumes of blood can be lost (1500ml)
what type of mechanisms are femoral shaft fractures usually seen in
high energy trauma
pathological fractures
fragility fractures (low energy trauma)
how is the proximal fragment in a femoral shaft fracture usually displaced and why
usually pulled into flexion and external rotation by iliopsoas and gluteus medius and minimus
what investigations would you need to do on top of the normal ones if this was (a) a high energy trauma case and (b) a pathological fracture
(a) routine urgent bloods, coagulation screen and group and save
(b) serum calcium and myeloma screen
management of femoral shaft fractures
immediate reduction and immobilisation
should be fixed surgically within 24-48 hours
most cases treated with an antegrade intermedullary nail
early mobilisation and physiotherapy
whereabouts does quadriceps tendon rupture usually occur
at the site of insertion with the superior pole of the patella
clinical features of a quadriceps tendon rupture
hearing a pop or feeling a tearing sensation, immediately followed by pain in the anterior thigh
localised swelling
inability to straight leg raise or extend the knee
investigations into a quadriceps tendon rupture
clinical diagnosis but an x-ray can show a caudally displaced patella and any underlying fractures
definitive diagnosis can be made via USS or MRI
management of quadriceps tendon rupture
depends on the degree of rupture
partial tears can be managed non-operatively providing the extensor mechanism is intact - this involves immobilisation of the knee in a brace + rehab
complete tendon tears require surgical intervention - either using longitudinal drill holes or suture anchors or end-to-end sutures. then put knee in a brace and immobilise for 6 weeks - followed by physio and rehab
what bones form the pelvic ring
ilium, ischium, pubis
sacrum
what is the most common mechanism of injury in pelvic fractures
high energy trauma e.g. road traffic accidents
falls from height
what is it important to check in pelvic fractures
full neurovascular assessment of the lower limbs, including checking anal tone
also check urethral injuries and open fractures (internal open fractures into the rectum and vagina)
management of pelvic fractures
ATLS guidelines as pelvic fractures are usually high energy injuries
stabilisation of the pelvis
pelvic fractures also cause significant blood loss, look out for signs of hypovolaemic shock
the need for immediate surgery depends; indications include haemorrhage, unstable fractures, open fractures, associated urological injury
complications following pelvic fracture and ways to stop this happening
DVT - thromboprophylaxis
main mechanism of injury for acetabular fractures
high energy trauma
falls from significant height
gold standard investigation for acetabular fracture
CT scan
management of acetabular fractures (old and young)
conservative; protected weight bearing for 6-8 weeks in minimally displaced fractures
surgical; in young patients the aim is to restore the anatomy of the joint, in the elderly fracture fixation is performed prior to a total hip athroplasty
what is the most common and second most common joint affected by osteoarthritis
knee is most common
hip is second most common
risk factors for osteoarthritis
increasing age, obesity, female gender, genetic factors, history of trauma to the hip, participation in high impact sports
characteristic findings on x-ray showing osteoarthritis
sunchondral bone cysts
reduced joint space
osteophyte formation
sunchondral sclerosis
clinical features of OA
pain aggravated by injury and relieved by rest, associated joint stiffness in the morning or when resting joint for a long period of time
management of OA
conservative; analgesia, lifestyle modifications e.g. quit smoking, lose weight, regular exercise and physio
surgical; total or hemi hip arthroplasty
