Hip fracture Flashcards
Hip fracture
A fracture of the femur above a point 5cm below most distal part of lesser trochanter
Classified by location
- Subcapital
- Transcervical
- Basicervical
- Intertrochanteric
- Subtrochanteric
Cost to NHS per year
£426 million
Impacted femoral neck fracture
Between base of neck and intertrochanteric line (90%)
Blood supply to femoral head disrupted >
Non-union and avascular necrosis of femoral head
Other fractures
- Displaced femoral neck fracture
- Intertrochanteric fracture
Blood supply to head of femur
Trochanteric anastomosis (circumflex), obturator, nutrient arteries
Blood supply to trochanteric area and upper femur
Cruciate anastomosis
Who?
Elderly, 87% > 65yrs, F>M 3:1, mean age 84
Aetiology
Simple fall standing > fragility fracture (rotational force)
Risk factors
Osteoporosis and falls
Pathophysiology
Osteoporosis, osteomalacia, bone metastases (bronchus, breast, kidney, prostate), haematological malginancy (myeloma/lymphoma), Paget’s disease
Clinical presentation
Fall, pain (groin/thigh/knee), difficulty weight-bearing, deformity (shortened limb/externally rotated)
Nerve supply and referred pain
Obturator
anterior - hip
posterior - knee
How soon should you have surgery?
Within 36 hours if medically stable
