Hip Fracture Flashcards
What is an iliofascial nerve block and when might it be indicated?
An iliofascial nerve block is an effective and commonly used method of analgesia for patients with a neck of femur fracture The Fascia iliaca compartment is an area of potential space that lies between the posterior surface of the fascia iliaca and the anterior surface of the iliacus and posts major muscles. Local anaesthetic injected into this potential space affects the femoral, obturator and lateral femoral cutaneous nerves. The aim of this is to reduce the use of opioids analgesics e.g. morphine, which is particularly helpful in elderly patients who are often more susceptible to their side effects. As the vast majority of patients with neck of femur fractures are elderly, an iliofascial nerve block (5) is now the recommended first line method of analgesia in most UK hospitals.
How are hip fractures classified?
Classification The Garden system is one classification system in common use. 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 bony contact. Type IV: Complete bony disruption. Blood supply disruption usual in 3 and 4.
When is a hip fracture intracapsular or extracapsular
The line between the greater and lesser trochanter marks the difference between intra and extracapsule fractures.
What is the significance of intra and extracapsular hip fractures?
The risk of reduced blood supply to head of femur is much greater in intracapsular fractures and therefore risk of vascular necrosis is increased. Management is therefore different. in elderly patients with an intracapsular injury a hemiarthroplasty is often necessary
how are hip fractures in the elderly managed?
How would a subtrochanteric fracture be managed? (5cm distal to the lesser trochanter)
Intramedullary device
If x ray showed no hip changes, but patient still symptomatic what is first line imaging according to nice?
MRI
In a young, fit patient with an intracapsular hip fracture (garden III) what treatment would be advised to minimise requirement for repeat operations?
reduction and fixation with cannulated screws
Hemi and full arthroplasty tends to be reserved for those over 70
when would a total hip replacement be contraindicated?
A total hip replacement would be indicated in an intracapsular fracture with displacment, however a hemiarthroplasty (cemented) would be preferred in a patient who is not independently mobile.
Time till weight bearing after hip fracture treated with dynamic hip screw
Encouraged full weight bearing immediately following dynamic hip screw operation
