Hip Flashcards
How will a leg look if the NOF is fractured ?
leg will be externally rotated and shortened
Which blood vessels can be damaged in a displced intracapsular fracture?
Circumflex arteries (medial more important)
What is the risk if the circumflex arteries are damaged in a NOF#
Avascular necrosis
What is the treatment for a displaced intracapsular #NOF?
Hemi arthroplasty or a total hip replacement
Only offer total hip replacement if
- Patient can walk independently with no more than a stick
- have no cognitive impairment
- are medically fit for anaesthesia and procedure.
What is an extracapsular fracture?
Fractures that occur outside of the capsule. Can be described as:
- intertrochanteric
- subtrochanteric
How do neck of femur fractures present?
Unable to weight bear
Leg is shortened and externally rotated
Pain in the groin radiating down the thigh
Reduced range of movement
What is the initial management for an neck of femur fracture?
A to E approach
Bedside tests: Sats, BP, HR, Temp, ECG (preop)
Bloods: FBC, U+Es, CRP, G+S, Clotting
Fluids (be wary of fluid overloading in elderly patients with other comorbidities) and transfusion (a lot of blood can be lost into the hip after #)
Analgesia - oral
Imaging: X-ray of hip - AP and Lateral
Call Ortho reg on call
What is the surgical treatment for an extracapsular fracture?
Intertrochanteric - dynamic hip screw and plate system after closed reduction
Subtrochanteric - intramedullary nail allowing force distribution arund the centre of the fracture line
Why isnt a dynamic hip screw used in a subtrochanteric fracture
These fractures are unstable and a DHS will result in failure of the metalwork and the superior cutting out of the screw
What are the complications of an extracapsular fracture
Blood loss in theatre VTE - MI, Stroke, PE, DVT Fat emboli (more common in intramedullary fixation) Malunion or non-union Infection
What are the complications of an intracapsular fracture?
avascular necrosis of the femoral head
What are the risk factors for #NOF?
Elderly Osteoporosis Female OA of the hip Age related issues which make a patient more likely to fall - dementia - poor vision - poor proprioception
What is osteoporosis
A condition in which there is a decline in bone mass and quality
It is related to reduced mobilisation, increasing age and being female
It makes the bone more likely to fracture
What is avascular necrosis
Loss of bone as a result of impaired blood supply leading to ischaemia.
Occurs in intracapsular NOF # due to disruption to the circumflex arteries which supply the femoral head.
What other fractures are often seen in elderly female and osteoporotic patients other than NOF fracture?
Distal radius
Vertebral compression fracture
What is a hemiarthroplasty?
Only the femoral head is replaced and the patient keeps their acetabulum
How is an undisplaced intracapsular NOF fracture treated?
In young patients or fit healthy elderly patients an undisplaced intracapsular fracture is treated by internal fixation
If elderly and lots of comorbidities then hemi is used.
What are the causes of osteoporosis
SHATTERED Family Steroid use - >5mg/day prednisolone Hyperthyroidism, hyperparathyroidism Alcohol or tobacco use Thin <22 BMI Testosterone low Early menopause Renal failure/ Liver failure Erosive/inflammatory bone disease e.g. RA, myeloma Dietary Calcium low/malabsorption, T1DM
What type of antibiotic prophylaxis regime is given in hemoarthroplasty or total hip replacement
IV Co-Amoxiclav
At induction, 8hrs and 16hrs after
If pencillin allergic
Teicoplaniin and Gentamycin
