Hip Factures Flashcards
Risk factors for hip fractures
Age (Average age 80 years old) Osteoporosis Smoking Steroids Low muscle mass Alcohol Female is (4x more common)
How do you differentiate intra vs extracapsular fractures? Types of extracapsular fractures
Demarcated by inter-trochanteric line (runs between greater and lesser trochanter) Above inter-trochanteric line = intracapsular fracture Below inter-trochanteric line = extracapsular fracture Extracapsular fracture types: - Trochanteric extracapsular fractures lie above the lesser trochanter - Subtrochanteric extracapsular fractures lie below the lesser trochanter
What is the blood supply to the proximal femur?
Mainly from the PROFUNDA FEMORIS which supply the medial circumflex and lateral circumflex vessels that form a ring around the femoral neck which then gives off RETICULAR VESSELS which supply femoral head Additional supply from: foveal artery (especially when younger) and metaphyseal vessels
Why are intracapsular hip fractures dangerous?
Because the fracture lies above the intertrochanteric line, the blood supply to the femoral head is at risk (the retinacular vessels from the medial and lateral circumflex arteries of the profunda femoris) So there is a risk of AVASCULAR NECROSIS OF THE FEMORAL HEAD
What investigations need to be done on someone coming in with a hip fracture? (Think pre-op too)
Bedside tests: - Observations - Urine Dip (UTIs common in elderly that can cause falls) - ECG (required pre-operatively and to ensure not silent MI) Blood tests: - FBC - U+Es - CRP (any current inflammation) - BONE PROFILE - Group and save for surgery - Clotting screen - Venous gas (ph, lactate) Imaging: - Pelvic X-ray (including hip, femur and knee): general rule of image the joint above and below = need to image entire length of femur - CT: if plain films are inconclusive - Chest X-ray: preoperatively Special tests: - e.g. if the patient has a pacemaker you need to check it pre-operatively
Classification of intracapsular neck of femur injuries
Hip Fractures
Intracapsular management
[1,2 screw; 3,4 Austin moore]
Gardens classification I and II low risk of AVN = Internal fixation with 2/3 screws
Gardens classification III and IV high risk of AVN
- Hemiarthroplasty (which Austin Moore is a type of) in the elderly because shorter operation so lower risk and lower risk of dislocation
- Total Hip Replacement in the young and fit because need better baseline mobility and gives better mobility
Hip Fractures
Extracapsular Management
Dynamic Hip Screw (DHS) for trochanteric extracapsular fractures which allow fracture ends to slide
Intramedullary nail (IM nail) for subtrochanteric extracapsular fractures
Complications of total hip replacement
Posterior hip dislocation (leg adducted, shortened and internally rotated)
