Hip Fracture Flashcards

1
Q

What is a hip fracture?

A

A break in the upper portion of the femur, proximal to the femoral head, in the region of the hip joint

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2
Q

Risk factors for hip fracture?

A

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

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3
Q

What type of joint is the hip joint?

A

A ball and socket joint formed by the articulation of the femoral head & acetabulum of the pelvis.

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4
Q

What 4 regions can the proximal femur be divided into?

A

1) Femoral head

2) Femoral neck

3) Trochanteric area

4) Subtrochanteric area

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5
Q

Hip fractures can be intracapsular or extracapsular.

What are the 2 types of intracapsular fractures?

A

1) Femoral head fractures

2) Femoral neck fractures (more common)

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6
Q

What are the 2 types of extracapsular fractures?

A

1) Intertrochanteric fractures

2) Subtrochanteric fractures

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7
Q

Where do intertrochanteric fractures occur?

A

Between the greater and lesser trochanter

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8
Q

Where do subtrochanteric fractures occur?

A

Below the lesser trochanter

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9
Q

What is one classification system commonly used in hip fractures?

A

Garden system

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10
Q

Describe type I to IV of the Garden system

A

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

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11
Q

Clinical features of hip fracture?

A
  • pain
  • shortened, externally rotated leg
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12
Q

Mx of hip fracture? (4)

A

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

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13
Q

What does internal fixation involve?

A

using screws, plates, or intramedullary nails to stabilise the fracture, allowing for bone healing.

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14
Q

What does hemiarthroplasty involve?

A

Replacing the femoral head and neck with a prosthesis, typically used for displaced femoral neck fractures in elderly patients

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15
Q

What does total hip arthroplasty involve?

A

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.

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16
Q

What mx is recommended for an undisplaced fracture?

A

internal fixation, or hemiarthroplasty if unfit.

17
Q

What mx is recommended for a displaced fracture?

A

Replacement arthroplasty (total hip replacement or hemiarthroplasty)

18
Q

Mx of extracapsular hip fracture?

A

stable intertrochanteric fractures: dynamic hip screw

if reverse oblique, transverse or subtrochanteric fractures: intramedullary device

19
Q

What are some fracture specific complications of a hip fracture?

A

1) Nonunion

2) Malunion

3) Avascular necrosis of femoral head

4) Hardware-related complications

5) Leg length discrepancy

20
Q

Nonunion vs malunion?

A

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.

21
Q

What is the investigation of choice in avascular necrosis of the hip?

A

MRI

22
Q

When is a DEXA scan is not necessary to diagnose osteoporosis?

A

Fragility fracture in women ≥75 y/o

23
Q

Is an intertrochanteric or subtrochanteric hip fracture more stable?

A

An intertrochanteric hip fracture is generally more stable.

24
Q
A