Hip and Proximal Femoral Fractures Flashcards
Most patients with hip fractures are what age?
What sex is more likely to suffer a hip fracture?
What is the lifetime risk of a hip fracture for a male/female aged > 50?
> 80
Females
Males = 5-10%, females = 15-20%
What are the 2 main reasons for hip fractures in elderly patients?
What effects do many of these patients having co-morbidities have?
Falls and osteoporosis
Increases the risk of falls, and increases risk of post-surgical complications
What can be some underlying causes of falls in an elderly patient?
Cerebrovascular disease
Arrhythmias
Postural hypotension
What is the mortality for a proximal femoral fracture at:
a) 1 month?
b) 4 months?
c) 1 year?
a) 10%
b) 20%
c) 30%
Why do patients with hip fractures usually undergo surgery, even with the risks of many co-morbidities?
Surgery for hip fractures should ideally be performed within how long?
What is the only situation in which surgery would not be performed?
If no surgery, the risks of prolonged bed rest are high. Also surgery is the best chance to allow patients to go home.
24-48 hours
If the patient has severe comorbities and is most likely going to die anyway
What are the 5 main surgical complications of hip replacement?
Failure of fixation
AVN
Non-union
Infection
Dislocation
Following a hip fracture, what generally happens to patients who previously had good mobility?
If patients previously lived independently, what is the chance of them requiring institutional care?
How many patients fail to return to pre-injury function?
They drop a level of mobility- tend to need frames/sticks ect
20%
30%
What are the 5 main clinical features of a hip fracture?
Shortening
External rotation
Trochanteric bruising
Unable to SLR
Severe groin pain on rotational movements
What is the relavence of classifying hip fractures based on their relation to the hip capsule?
Assesses the likelihood of disruption of blood supply to the femoral head (AVN)
Where does the arterial supply to the femoral head come from?
The medial and lateral circumflex arteries are branches of where?
A ring anastamosis of circumflex femoral arteries at the insertion of the hip capsule at the base of the femroral neck
Profunda femoris artery
What investigations may be required for hip fractures?
X-ray (AP and lateral)
MRI if not visible on x-ray
Which type of hip fractures have a higher risk of AVN?
Why?
In these fractures there is also a higher risk of what else?
Intracapsular
The blood supply to the femoral head is disrupted
Non-union (20%)
What is the best treatment for an intracapsular hip fracture?
What is this?
Who are these given to?
THR
Replacement of the femoral head and the acetabulum
Higher functioning hip fracture patients
What is the ‘2nd line’ treatment for an intracapsular hip fracture?
What does this involve?
Who gets this treatment?
Hemiarthroplasty
Replacement of the femoral head only
Patients with restricted motility or cognitive deficits
What is the advantage and disadvantage of THR when compared to hemiarthroplasty?
Better functional outcomes
Higher dislocation rate
What is the treatment for an intracapsular hip fracture in a patient < 60 with good mobility?
ORIF
Do extracapsular hip fractures cause AVN and non-union?
No
How are extracapsular hip fractures mainly treated?
They will generally heal in what position?
Dynamic hip screw and IM nail/plate
Shortened position
Who do subtrochanteric fractures usually occur in?
What is the mchanism of injury?
Patients with osteoporosis
Fall onto the side
Why do subtrochanteric fractures have a high risk of non-union?
The blood supply to the site is not good
The bone is under considerable bending stress
Subtrochanteric fractures can be associated with long term use of what medication?
What is used to treat these pre-op?
What surgical management is used?
Bisphosphonates
Thomas splint
IM nail
How will patients with pubic rami fractures present?
How are these treated?
Tender groin but less pain on rotation than a hip fracture
Conservatively
How are greater trochanter fractures treated?
You should use an MRI to assess what?
If the above is the case, how does this alter the management?
Conservatively
If the fracture transverses the femoral neck
Internal fixation should be used
Patients with a hip fracture should be admitted to an acute orthopaedic ward within how long since presentation?
All patients who are medically fit should have surgery within how long since admission?
All patients should be assessed and cared for to minimise their risk of developing what?
4 hours
48 hours
Pressure ulcers
All patients with fragility fractures should be assessed to determine their need for what?
Anti-resorptive therapy to prevent future osteoporotic fractures
What are the main 6 interventions which should be performed in A and E in patients with a hip fracture?
Analgesia
NEWS
Pressure area inspection
Blood tests
Fluid therapy
Delirium screening
Patients with a hip fracture should have a physiotherapy assessment by when?
Patients with a hip fracture should have an occupational therapy appointment by when?
Day 2
Day 3 (post-op)
Pressure ulcers can start to develop within how long lying on a hard surface?
What do these cause?
30 minutes
Pain and immobility which limits rehab from surgery
What methods of pain relief are used now for hip fractures?
If patients are post-op on morphine and are confused, what can be used instead?
What are 4 side effects of opiate analgesics?
Local nerve blocks
Oxycodone
Drowsiness, confusion, constipation, dizziness
Patients with a fragility fracture should take supplements of what?
What investigation may be organised as an outpatient appointment following a hip fracture?
Calcium and vitamin D
DEXA scan
