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
