hip fracture

Question 1

what is the management for a displaces intracpsular hip fracture?

Answer 1

semi or total arthroplasty

unless not displaced, in which case can be treated with internal fixation

Question 2

what is the management of extracpsular hip fractures?

Answer 2

extra-capsular fractures leave the blood supply of the head of the femur intact

1. stable intertrochanteric= DHS
2. reverse oblique, transverse and subtrochanteric= intramedullary device

Question 3

how quickly do we aim for surgery of hip fractures?

Answer 3

within 48 hours

Question 4

what is the blood supply to the head of the femur?

Answer 4

retrograde blood supply.

The medial and lateral circumflex femoral arteries join the femoral neck just proximal to the intertrochanteric line

Question 5

which classification us used for intracapsular neck of femur fractures?

Answer 5

Grade I – incomplete fracture and non-displaced
Grade II – complete fracture and non-displaced
Grade III – partial displacement (trabeculae are at an angle)
Grade IV – full displacement (trabeculae are parallel)

Question 6

how do patients with hip fractures present?

Answer 6

Pain in the groin or hip, which may radiate to the knee
Not able to weight bear
Shortened, abducted and externally rotated leg

Question 7

what s the management of hip fracture patients?

Answer 7

Appropriate analgesia
Investigations to establish the diagnosis (e.g., x-rays)
Venous thromboembolism risk assessment and prophylaxis (e.g., low molecular weight heparin)
Pre-operative assessment (including bloods and an ECG) to ensure they are fit and optimised for surgery
Orthogeriatrics input

Question 8

what is used to assess severity of hip arthritis?

Answer 8

Oxford hip score

Question 9

what are red flag features of arthritis of the hip?

Answer 9

rest pain, night pain and morning stiffness > 2 hours

Question 10

what are the preoperative complications of a total hip replacement?

Answer 10

• venous thromboembolism
• intraoperative fracture
• nerve injury
• surgical site infection

Question 11

what are post op complications of a hip fracture?

Answer 11

• leg length discrepancy
• posterior dislocation
• aseptic loosening (most common reason for revision )

Question 12

how does a posterior hip dislocation present?

Answer 12

may occur during extremes of hip flexion

typically presents acutely with a ‘clunk’, pain and inability to weight bear

on examination there is internal rotation and shortening of the affected leg