Hip Fracture Flashcards
What is a hip fracture?
A break in the upper portion of the femur, proximal to the femoral head, in the region of the hip joint
Risk factors for hip fracture?
1) age
2) sex (women more susceptible due to a higher prevalence of osteoporosis)
3) osteoporosis
4) previous fractures
5) falls
6) lifestyle:
- smoking
- alcohol
- physical inactivity
What type of joint is the hip joint?
A ball and socket joint formed by the articulation of the femoral head & acetabulum of the pelvis.
What 4 regions can the proximal femur be divided into?
1) Femoral head
2) Femoral neck
3) Trochanteric area
4) Subtrochanteric area
Hip fractures can be intracapsular or extracapsular.
What are the 2 types of intracapsular fractures?
1) Femoral head fractures
2) Femoral neck fractures (more common)
What are the 2 types of extracapsular fractures?
1) Intertrochanteric fractures
2) Subtrochanteric fractures
Where do intertrochanteric fractures occur?
Between the greater and lesser trochanter
Where do subtrochanteric fractures occur?
Below the lesser trochanter
What is one classification system commonly used in hip fractures?
Garden system
Describe type I to IV of the Garden system
Type I: Stable fracture with impaction in valgus
Type II: Complete fracture but undisplaced
Type III: Displaced fracture, usually rotated and angulated, but still has boney contact
Type IV: Complete boney disruption
Clinical features of hip fracture?
- pain
- shortened, externally rotated leg
Mx of hip fracture? (4)
Options depend on patient’s age, overall health, and the type of fracture.
1) Internal rotation
2) Hemiarthroplasty
3) Total hip arthroplasty
4) Conservative management
What does internal fixation involve?
using screws, plates, or intramedullary nails to stabilise the fracture, allowing for bone healing.
What does hemiarthroplasty involve?
Replacing the femoral head and neck with a prosthesis, typically used for displaced femoral neck fractures in elderly patients
What does total hip arthroplasty involve?
Replacing both the femoral head and the acetabulum with prosthetic components, usually indicated for patients with pre-existing hip joint arthritis or those who may not be suitable candidates for hemiarthroplasty.
What mx is recommended for an undisplaced fracture?
internal fixation, or hemiarthroplasty if unfit.
What mx is recommended for a displaced fracture?
Replacement arthroplasty (total hip replacement or hemiarthroplasty)
Mx of extracapsular hip fracture?
stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device
What are some fracture specific complications of a hip fracture?
1) Nonunion
2) Malunion
3) Avascular necrosis of femoral head
4) Hardware-related complications
5) Leg length discrepancy
Nonunion vs malunion?
Nonunion occurs when the fractured bone fails to heal.
Malunion refers to the healing of a fracture in an abnormal position, which can result in pain, reduced range of motion, and joint instability.
What is the investigation of choice in avascular necrosis of the hip?
MRI
When is a DEXA scan is not necessary to diagnose osteoporosis?
Fragility fracture in women ≥75 y/o
Is an intertrochanteric or subtrochanteric hip fracture more stable?
An intertrochanteric hip fracture is generally more stable.
