hip fractures Flashcards
major risk factors
age
osteoporosis
when is surgery aimed to be performed
within 48htrs
how can hip fractures be categorised
intra-capsular # (subcapital)
extra-capsular #
head of femur blood supply
retrograde - supplied by medial + lateral circumflex femoral arteries
if cut off due to # –> lack blood supply –> avascular necrosis
patients with displaced intra-capsular fracture need……
to have femoral head replaced with a hemiarthroplasty or total hip replacement
capsule of hip joint
strong fribrous structure
attatches to rim of acetabulum and the intertrochanteric line on femur
surrounds neck and head of femur
intra-capsular fractures
break in femoral neck, within capsule of hip joint
affects area proximal to intertrochanteric line
Garden classification
used for intra-capsular neck of femur fractures
Garden classification: Grade I
incomplete fracture
non-displaced
Garden classification: Grade II
complete fracture
non-displaced
Garden classification: Grade III
partial displacement (trabeculae are at an angle)
Garden classification: Grade IV
full displacement (trabeculae parallel)
management of non-displaced intra-capsular #
can be treated with internal fixation
displaced intra-capsular #management
grade III and IV distrupt the blood supply to femur head
head of femur need to be removed and replaced
hip hemiarthroplasty
replace head of femur and leave acetabulum in place
pt with limited mobility or significant co-morbidities
total hip replacement
replace head of femur and acetabulum
pt who walk independantly and fit for surgery
extra-capsular fractures: intertrochanteric #
occur between greater and lesser trochanter
extra-capsular fractures: intertrochanteric # management
dynamic hip screw (sliding hip screw)
extra-capsular fractures: subtrochanteric #
occur distal to lesser trochanter (within 5cm)
proximal to shaft of femur
extra-capsular fractures: subtrochanteric # management
intramedullary nail
hip # presentation - typical scenario
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
hip # - sign
shortened, abducted and externally rotated leg
imaging
X-ray (AP and lateral views)
MRI or CT if x-ray negative but strong suspicion
key x-ray sign of fractured neck of femur
disruption of shenton’s line (seen on AP view)
hip # - management upon patient admission
analgesia
investigations
VTE risk assessment and prophylaxis
pre-op assessment
