Hip and Proximal and Shaft Femoral Fractures

Question 1

Why are almost all hip fractures treated surgically?

Answer 1

Early mobilisation and resoration of function is more likely to be possible and rehabilitation is more likely

Question 2

How are hip fractures broadly classified?

Answer 2

1. Intracapsular
2. Extracapsular

Question 3

What is the main blood supply of the femoral head?

Answer 3

Anastamotic ring

(medial and lateral circumflex arteries fromt the profunda femoral artery)

Question 4

What is the main risk associated with an intracapsular hip fracture?

Answer 4

Avascular necrosis

(blood supply is disrupted)

Question 5

What are the two main treatment options for an intracapsular hip fracture?

Answer 5

1. Hemiarthroplasty
2. Total hip replacement

Question 6

When would a hemiarthroplasty be preferred over a total hip replacement for an intracapsular hip fracture?

Answer 6

1. Reduced mobility
2. Cognitively impaired

Question 7

When would a total hip replacement be preferred over a hemiarthroplasty for an intracapsular hip fracture?

Answer 7

1. Mobile patient
2. No cognitive impairments

(Total hip replacements are more likely to dislocate)

Question 8

Why is it preferrable to have an extra-capsular hip fracture compared with an intra-capsular hip fracture?

Answer 8

1. Blood supply to the femoral head remains intact
2. There is a much higher union rate

Question 9

How can an extra-capsular hip fracture be treated?

Answer 9

Internal fixation (compression or dynamic hip screw)

Question 10

Subtrochanteric fractures usually occur in which patients?

Answer 10

Elderly osteoporotic patients who fall onto their side

Question 11

Why do subtrochanteric fractures take a long time to heal?

Answer 11

1. There is a relatively poor blood supply
2. Non-union occurs frequently

Question 12

What is the recommended treatment for an intertrochanteric fracture?

Answer 12

Intramedullary nail

(prevents further blood supply disruption)

Question 13

For patients with a subtrochanteric proximal femoral fracture what can aid with pre-operative pain and fracture stabilisation?

Answer 13

Thomas splint

Question 14

In a patient with no comorbidities, under which circumstances would a femoral shaft fracture occur?

Answer 14

High energy injuries

Question 15

Stress fractures of the femoral shaft may occur in the presence of which co-morbid conditions?

Answer 15

1. Osteoporosis
2. Metastatic disease
3. Paget’s disease
4. Long term bisphosphonate use

Question 16

In terms of femoral shaft fractures, what are two key dangers?

Answer 16

1. High blood loss
2. Fat from medullary canal can enter the damaged venous system causing a fat embolism resulting in confusion, hypoxia and risk of ARDS

Question 17

What is the initial management for a femoral shaft fracture?

Answer 17

1. Analgesia with femoral nerve block
2. Application of Thomas splint

Question 18

What is the definitive management for a femoral shaft fracture?

Answer 18

Closed reduction and stabilisation with intrameduallary nail

or

Minimally invasive plate fixation