Hip fracture Flashcards
what is the blood supply to the femoral head?
- profunda femoris artery gives rise to medial and lateral circumflex femoral artery
- obturator artery gives rise to vessel within ligamentum teres
- medial femoral circumflex supplies greater trochanter
how can you divide hip fractures initially?
what is the important thing about one of them?
- intracapsular and extra capsular
- intracapsular affects the femoral neck, which may lead to AVN of femoral head
what is the Garden classification?
Type 1: stable fracture with impaction
Type 2: Complete fracture but undisplaced
Type 3: displaced head but still in contact with bone
Type 4: displaced head, complete disruption
who is more likely to get fractured NOF?
- Old women (F:M 3:1)
- 50% of >80 y/o
what are the risk factors?
Think shattered
- steroids
- hyperparathyroidism
- alcohol and smoking
- thin
- testosterone
- early menopause
- renal/ liver failure
- erosive bone disease
- dietary
how might they present?
- pain in upper outer thigh
- affected leg shortened, adducted and externally rotated
- inability to weight bear
what bloods would you want?
what X-ray views?
what will you look for on X-ray?
- FBC, U+Es, G+S
- AP + lateral XR
- broken shenton line
- intra/ extra capsular
- displacement
how can you subdivide extracapsular fractures?
- trochanteric (involves/ between trochanters)
- non- trochanteric (fracture below lesser trochanter)
how should it be managed surgically?
- ABCDE
- orthopaedic consult, surgery within 1 day
- Intracapsular:
ORIF with screws if Garden 1+2
Arthroplasty (replacement) if 3+4 - Extracapsular: ORIF with dynamic hip screw
what other general things need to be done?
- Large IV access: in case of transfusion
- morphine (femoral nerve block if needed)
- VTE prophylaxis
- Splint to reduce blood loss
Complications?
- massive haemorrhage
- AVN
- delayed union
- infection
- DVT
- fat embolism
- 30% mortality @ 1 year
