Hip and Knee Fractures

Question 1

What is this a presentation of?

Shortened and internally rotated leg.

Answer 1

Posterior hip dislocation

Question 2

What is this a presentation of?

Abducted and externally rotated leg.

Answer 2

Anterior hip dislocation

Question 3

Which is more common, posterior or anterior hip dislocation?

Answer 3

Posterior

Question 4

What is this a presentation of?
Pain in hip after trauma/fall, inability to weight bear. External rotation, adduction, and shortening of the affected leg.

Answer 4

Fractured neck of femur

Question 5

What is at high risk of compromise in a fractured neck of femur?

Answer 5

Medial femoral circumflex artery

Question 6

What are the different types of fracture in the neck of femur?

Answer 6

1. Intracapsular - subcapital, midcervical, basicervical

2. Extracapsular - intertrochanteric, subtrochanteric

Question 7

What is the management of a fractured neck of femur in a patient under 55 years old?

Answer 7

Reduction and internal fixation

Question 8

What is the management of an non-displaced fractured neck of femur in a patient over 55 years old?

Answer 8

Cannulated hip screw

Question 9

What is the management of a displaced intracapsular fractured neck of femur in a patient over 55 years old?

Answer 9

Hemiarthroplasty or total hip replacement if normally fit.

Question 10

What is the management of an intertrochanteric fractured neck of femur in a patient over 55 years old?

Answer 10

Dynamic hip screw fixation

Question 11

What is the management of a subtrochanteric fractured neck of femur in a patient over 55 years old?

Answer 11

Intramedullary nail/hip screw

Question 12

What is the prognosis for an elderly patient with a hip fracture (mortality)?

Answer 12

8% die within 1 month, 30% die within 1 year.

Question 13

How is a fractured neck of femur managed medically?

Answer 13

1. Analgesia - IV morphine, antiemetic
2. Imaging - x-ray, MRI
3. Theatre - FBC, clotting, U&Es, CXR, ECG, crossmatch 2 units of RBCs
4. Manage co-morbidities with geriatrician
5. Early mobilisation and post-op anticoagulation
6. Good nutrition

Question 14

How are hip fractures prevented in the elderly?

Answer 14

1. Prevent falls - good lighting, less sedation, keep fit programmes
2. Exercise and balance training
3. Prevent osteoporosis - exercise, bisphosphonates
4. Ensure good vitamin D and calcium

Question 15

What are the potential complications of a pubic ramus fracture?

Answer 15

1. Laceration of bladder, vagina, and perineum - surgical management
2. High impact, so can cause haemorrhage and haemodynamic compromise

Question 16

What causes a patella fracture, and how is it investigated and managed?

Answer 16

1. Due to direct blow/axial load onto flexed knee (RTC)
2. X-ray shows lipo/haemoarthrosis
3. Non-displaced, conservative with brace; displaced, surgical k wires.