Hip Fracture

Question 1

PROGNOSIS

30 day mortality

Answer 1

5-10%

Question 2

AETIOLOGY

Risk factors

Answer 2

• Osteoporosis
• Older age
• Falls
• Low BMI
• Female
• High-energy trauma

Question 3

EPIDEMIOLOGY

M or F

Answer 3

Females more

Question 4

AETIOLOGY

Most common cause

Answer 4

Falls from standing height in older people

High energy trauma in younger people

Question 5

Hip fracture classification

Answer 5

• Intra-capsuilar fractures
  
  • Retinicular vessels may be damaged
• Extra-capsular fractures
  
  • Include thochanteric or subtrochanteric which typically heal well

Question 6

What is capsule hip joint

Answer 6

Fibrous structure that attaches to rim of acetabulum on pelvis and intertrochanteric line on femur, surrounds neck and head of femur

Question 7

What is main consequence difference in intra and extra capsular

Answer 7

• Head of femur has retrograde blood supply - medial circumflex femoral artery
  
  • Only blood supply
• Fracture of intra-capsular neck of femur can damage these vessels and cause avascular necorisis

Question 8

How can intra-capsular fracture be classified

Answer 8

• Garden classification
  
  • Grade 1 - incomplete fracture and non-displaced
  • Grade 2 - complete fracture and non-displaced
  • Grade 3 - partial displacement (trabeculae are at an angle)
  • Grade 4 - full displacement (trabeculae are parallel)

Question 9

Difference in management of non-displaced and displaced intra-capsular fractures

Answer 9

• Non-displaced
  
  • May have intact blood supply
  • So possible to preserve femoral health without avascular necrosis occuring, treated with internal fixation
• Displaced
  
  • Disrupt blood supply
  • Head of femur needs removed and replaced

Question 10

Options for replacement

Answer 10

• Hemiarthroplasty
  
  • Replacing head of femur but leaving acetabulum
  • Offered to limited mobility or significant co-morbidities
• Total hip replacement
  
  • replacing head of femur and socket
  • Offered to patients who walk independently and fit for surgery

Question 11

How are extra-capsular fractures treated

Answer 11

• Intertrochanteric
  
  • Dynamic hip screw
• Subtrochanteric
  
  • Intramedullary nail

Question 12

CLINICAL FEATURES

Presentation

Answer 12

• Pain in groin, may radiate to knee
• Not able to weight bear
• Shortened, abducted and externally rotated leg

Question 13

What position is leg in

Answer 13

Shortened, abducted and externally rotated

Question 14

INVESTIGATIONS

First choice

Answer 14

• X-rays
  
  • Two views (AP and lateral)
• MRI or CT
  
  • When x-ray is negative but fracture still suspected

Question 15

What is seen on x-ray in fracture of neck of femur

Answer 15

• Shentons line is disrupted
  
  • This is continuous curving line formed by medial border of femoral neck and continues to inferior border of superior pubic ramus

Question 16

MANAGEMENT

General priciples

Answer 16

• Analgesia
• Investigations
• VTE risk assessment and prophylaxis
• Pre-operative assessment (bloods and ECG)
• Orthogeriatric input

Question 17

What is used for VTE prophylaxis

Answer 17

Low molecular weight heparin

Question 18

COMPLICATIONS

Answer 18

• Avascular necrosis
• Non-union
• Thromboembolic complications