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Orthopaedics (Surgery) > Hip > Flashcards

Hip Flashcards

1
Q

what are the 2 main different types of NOF fractures

A

intracapsular or extracapsular (intertrochanteric and subtrochanteric)

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2
Q

describe the blood supply of the femoral head and what arteries are responsible (in adults and children)

A

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

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3
Q

intracapsular NOF fractures are classified using what system - and describe it

A

garden classification system

organised into displaced vs non-displaced and then partial or full displacement

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4
Q

on examination, how does a NOF fracture present

A

affected leg is characteristically shortened and externally rotated

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5
Q

investigations into NOF fractures

A

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

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6
Q

different types of surgical management of a NOF fracture

A

hip hemiarthroplasty and total arthroplasty

dynamic hip screws

intermedullary nails

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7
Q

when would you consider a hemi vs total hip arthroplasty

A

consider total hip arthroplasty in patients who were systemically well and living independently prior to injury

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8
Q

what would be the most appropriate surgical intervention for a subtrochanteric femoral fracture

A

intramedullary femoral nail

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9
Q

what are distal femur fractures classified into

A

extra-articular (type A)

partial articular (type B)

complete articular (type C)

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10
Q

what is a Hoffa fracture

A

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

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11
Q

management of distal femur fractures

A

resus and stabilisation as per ATLS guidelines

initial realignment and then immobilisation using skin traction

then definitive management involves retrograde nailing or ORIF

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12
Q

what artery/branches supply blood to the femur

A

penetrating branches of the profunda femoris artery

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13
Q

why can large volumes of blood be lost in femoral shaft fractures

A

highly vascularised bone due to its role in haematopoiesis

large volumes of blood can be lost (1500ml)

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14
Q

what type of mechanisms are femoral shaft fractures usually seen in

A

high energy trauma

pathological fractures

fragility fractures (low energy trauma)

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15
Q

how is the proximal fragment in a femoral shaft fracture usually displaced and why

A

usually pulled into flexion and external rotation by iliopsoas and gluteus medius and minimus

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16
Q

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

(a) routine urgent bloods, coagulation screen and group and save
(b) serum calcium and myeloma screen

17
Q

management of femoral shaft fractures

A

immediate reduction and immobilisation

should be fixed surgically within 24-48 hours

most cases treated with an antegrade intermedullary nail

early mobilisation and physiotherapy

18
Q

whereabouts does quadriceps tendon rupture usually occur

A

at the site of insertion with the superior pole of the patella

19
Q

clinical features of a quadriceps tendon rupture

A

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

20
Q

investigations into a quadriceps tendon rupture

A

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

21
Q

management of quadriceps tendon rupture

A

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

22
Q

what bones form the pelvic ring

A

ilium, ischium, pubis

sacrum

23
Q

what is the most common mechanism of injury in pelvic fractures

A

high energy trauma e.g. road traffic accidents

falls from height

24
Q

what is it important to check in pelvic fractures

A

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)

25
Q

management of pelvic fractures

A

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

26
Q

complications following pelvic fracture and ways to stop this happening

A

DVT - thromboprophylaxis

27
Q

main mechanism of injury for acetabular fractures

A

high energy trauma

falls from significant height

28
Q

gold standard investigation for acetabular fracture

A

CT scan

29
Q

management of acetabular fractures (old and young)

A

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

30
Q

what is the most common and second most common joint affected by osteoarthritis

A

knee is most common

hip is second most common

31
Q

risk factors for osteoarthritis

A

increasing age, obesity, female gender, genetic factors, history of trauma to the hip, participation in high impact sports

32
Q

characteristic findings on x-ray showing osteoarthritis

A

sunchondral bone cysts

reduced joint space

osteophyte formation

sunchondral sclerosis

33
Q

clinical features of OA

A

pain aggravated by injury and relieved by rest, associated joint stiffness in the morning or when resting joint for a long period of time

34
Q

management of OA

A

conservative; analgesia, lifestyle modifications e.g. quit smoking, lose weight, regular exercise and physio

surgical; total or hemi hip arthroplasty

Orthopaedics (Surgery) (10 decks)

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