Hip fractures

Question 1

What is a neck of femur fracture?

Answer 1

A fracture that occurs between the femoral head to 5cm distal to the lesser trochanter

Question 2

What are the different types of neck of femur fractures?

Answer 2

Intracapsular - proximal to inter-trochanteric line

Extracapsular

• inter-trochanteric (between the greater and lesser trochanters)
• sub-trochanteric (up to 5 cm below lesser trochanter)

Question 3

What are risk factors for hip fractures?

Answer 3

Old age
Osteoporosis
Trauma

Question 4

Describe the blood supply to the head of the femur

Answer 4

Retrograde blood supple
The deep femoral a. gives off the lateral circumflex and the medial circumflex femoral arteries. These join at the femoral neck and give off branches (retinacular arteries) to the femoral head

Question 5

What is a complication of displaced intracapsular hip fractures?

Answer 5

Avascular necrosis of the femoral head (due to cut off retrograde blood supply)

Question 6

How do neck of femur fractures commonly present?

Answer 6

Prior trauma
Pain - groin or hip - may radiate to the knee
Inability to weight bear

On examination - normally - leg shortened + abducted + externally rotated

Question 7

What are some complications of neck of femur fractures?

Answer 7

Joint dislocation
Deep infection / prosthetic joint infection
Less independence
Complications of the operation
Death

Question 8

What is the generalised management for hip fractures?

Answer 8

Analgesia
VTE risk assessment + prophylaxis
Pre operative assessment - including bloods + ECG

Surgery
Then early mobilisation

Question 9

What surgical management is used for non displaced intra-capsular hip fractures?

Answer 9

Internal fixation - e.g. screws to hold the femoral head in place

(as long as there is intact blood supply + no )avascular necrosis

Question 10

What surgical management is used for displaced intra- capsular hip fractures.

Answer 10

Hemiarthroplasty (replacing head of femur but leaving acetabulum)

or

Total hip placement - offered to otherwise well patients

Question 11

What surgical management is used for extra capsular hip fractures?

Answer 11

Hip screws (different ones depending on the location)