hip fractures

Question 1

major risk factors

Answer 1

age

osteoporosis

Question 2

when is surgery aimed to be performed

Answer 2

within 48htrs

Question 3

how can hip fractures be categorised

Answer 3

intra-capsular # (subcapital)

extra-capsular #

Question 4

head of femur blood supply

Answer 4

retrograde - supplied by medial + lateral circumflex femoral arteries

if cut off due to # –> lack blood supply –> avascular necrosis

Question 5

patients with displaced intra-capsular fracture need……

Answer 5

to have femoral head replaced with a hemiarthroplasty or total hip replacement

Question 6

capsule of hip joint

Answer 6

strong fribrous structure

attatches to rim of acetabulum and the intertrochanteric line on femur

surrounds neck and head of femur

Question 7

intra-capsular fractures

Answer 7

break in femoral neck, within capsule of hip joint

affects area proximal to intertrochanteric line

Question 8

Garden classification

Answer 8

used for intra-capsular neck of femur fractures

Question 9

Garden classification: Grade I

Answer 9

incomplete fracture

non-displaced

Question 10

Garden classification: Grade II

Answer 10

complete fracture

non-displaced

Question 11

Garden classification: Grade III

Answer 11

partial displacement (trabeculae are at an angle)

Question 12

Garden classification: Grade IV

Answer 12

full displacement (trabeculae parallel)

Question 13

management of non-displaced intra-capsular #

Answer 13

can be treated with internal fixation

Question 14

displaced intra-capsular #management

Answer 14

grade III and IV distrupt the blood supply to femur head

head of femur need to be removed and replaced

Question 15

hip hemiarthroplasty

Answer 15

replace head of femur and leave acetabulum in place

pt with limited mobility or significant co-morbidities

Question 16

total hip replacement

Answer 16

replace head of femur and acetabulum

pt who walk independantly and fit for surgery

Question 17

extra-capsular fractures: intertrochanteric #

Answer 17

occur between greater and lesser trochanter

Question 18

extra-capsular fractures: intertrochanteric # management

Answer 18

dynamic hip screw (sliding hip screw)

Question 19

extra-capsular fractures: subtrochanteric #

Answer 19

occur distal to lesser trochanter (within 5cm)

proximal to shaft of femur

Question 20

extra-capsular fractures: subtrochanteric # management

Answer 20

intramedullary nail

Question 21

hip # presentation - typical scenario

Answer 21

older patient (>60) who as fallen presenting with

• pain in groin or hip, may radiate to knee
• not able to weight bear
• shortened, abducted and externally rotated leg

Question 22

hip # - sign

Answer 22

shortened, abducted and externally rotated leg

Question 23

imaging

Answer 23

X-ray (AP and lateral views)

MRI or CT if x-ray negative but strong suspicion

Question 24

key x-ray sign of fractured neck of femur

Answer 24

disruption of shenton’s line (seen on AP view)

Question 25

hip # - management upon patient admission

Answer 25

analgesia
investigations
VTE risk assessment and prophylaxis
pre-op assessment