Hip and pelvic fractures Flashcards
What are hip fractures?
Fractures to the femoral neck
Who most commonly fractures the hip?
Over 60
Females
What is a possible cause of hip fracture in younger patients?
High energy trauma (e.g. car crash)
What are some factors that increase risk of hip fracture?
- Osteoporosis
- Smoking
- Malnutrition
- Excess alcohol
- Neurological impairment
- Impaired vision
- Low BMI
- Age (Increased fall risk)
What are the 2 main types of hip fracture?
Extra-capsular
Intra-capsular
What are the 2 main types of extra-capsular fracture?
Sub-trochanteric fracture
Trochanteric fracture
What are the 3 types of trochanteric fracture?
Basicervical
Intertrochanteric
Reverse oblique
What is meant by a sub-trochanteric fracture?
Fractures found below the lesser trochanter
What is meant by a trochanteric fracture?
Fractures found between the lesser and greater trochanter
What is meant by an intra-capsular fracture?
Fractures found between trochanters and femoral head
What type of fracture is shown by the red line?
Basicervical
What type of fracture is shown by the yellow line?
Intertrochanteric
What type of fracture is shown by the green line?
Reverse oblique
What are the two types of intra-capsular fracture?
Sub-capital
Trans-cervical
What is shown by the yellow line?
Sub-capital
What is shown by the green line?
Trans-cervical
How will hip fracture usually present?
Inability to bear weight
Pain in hip
What investigations are required in hip fracture?
Thorough history
ECG
Blood tests
X-ray
MRI or CT if unsure
What will X-ray show in hip fracture?
Broken Shenton’s line
What is Shenton’s line?
This is a smooth line following the superior pubic ramus, then down to the femoral shaft
What are the 3 questions asked to determine surgical management of hip fractures?
- Is it intra- or extra- capsular?
- Is it displaced?
- What is the function and comorbidities of the patient?
What surgery is performed in displaced, high function, intra-capsular hip fracture?
Total hip replacement
What surgery is performed in undisplayed, high function, intra-capsular hip fracture?
Compression hip screw
What surgery is performed in low function, intra-capsular hip fracture?
Hemi-arthroplasty
What surgery is performed in inter-trochanteric, extra-capsular hip fracture?
Dynamic hip screw
What surgery is performed in sub-trochanteric, extra-capsular hip fracture?
Intra-medullary nail
What is important about fractures to a ring structure?
They very rarely break in only one place (Imaging trying to break a polo mint in only one place)
What are some types of pelvic fracture?
Open book fracture
Pubic ramus fracture
What is shown on this X-ray?
Open book fracture (Pubic symphysis opened)
What is shown on this X-ray?
Right sided pubic ramus fracture
What classification system is used for pelvic fracture?
Young-Burgess classification
What is the first aid management of pelvic fracture?
First aid management is a pelvic binder, which applies pressure to prevent opening or blood loss into the pelvic cavity
This also helps with pain
How are pelvic ramus fractures and other stable, undisplayed fractures managed?
Conservatively, using pain relief and physiotherapy
How are unstable, displaced or fractures in young patients usually managed?
ORIF
