hip Flashcards
define hip fracture
femoral head to 5cm below LT
why NOF leads to AVN commonly?
intracapsular, lacks periosteal layer which limits callus formation and slows healing
NOF exam findings 3
shortened, abducted, ER leg
deforming forces of NOF fx 3
flexion/shortening: hip flexors
abduction: glute medius
ER: short external rotators
complications of NOF 3
AVN
DVT
non-union
Garden classification for intracapsular NOF
Garden 1: valgus impacted, partial, undisplaced
Garden 2: complete fx, undisplaced
Garden 3: moderately displaced, minimal disturbance of trabecular pattern
Garden 4: very displaced, extreme disturbance of trabecular pattern
NOF tx
Garden 1&2: fixation with cannulated screws or DHS
Garden 3&4: if young then ORIF with Gamma nail
if old then hemi or THR depending on previous mobility
most important factor in NOF fx survival
previous baseline mobility
intracapsular divisions NOF 3
head
subcapital
transcervical
extracapsular divisions 3
basicervical
intertrochanteric
subtrochanteric
what doesnt garden classification take into account?
posterior tilt, any posterior tilt >10 degrees is considered displaced
Pauwel classification (intracapsular)
1: 30
2: 50
3: 70
line drawn across fx and horizontal line
1&2 stable can use screws
3 subject to shear, requires DHS
Evans classification (extracapsular)
extracapsular tx (inter or subtrochanteric)
DHS or IM nail
when to use IM nail over DHS in intertrochanteric fx 4 (PISR)
PM communition
incompetent lateral wall GT
subtrochanteric extension
reverse obliquity
