Hip fractures Flashcards
Risk factors for hip fractures
Increasing age
Osteoporosis
Female
Classification of hip fractures
Intracapsular
Extracapsular
What are intracapsular fractures?
Fractures proximal to the intra-trochanteric line
What is the risk associated with intracapsular fractures?
Avascular necrosis due to the retrograde blood supply to the femoral head
Blood supply passes from distal to proximal
Blood supply is predominantly through the medial circumflex femoral artery (lies directly on the intra-capsular femoral neck)
How are intracapsular fractures classified?
The Garden classification
Grade I – incomplete fracture and non-displaced
Grade II – complete fracture and non-displaced
Grade III – partial displacement (trabeculae are at an angle)
Grade IV – full displacement (trabeculae are parallel)
Non-displaced intracapsular NOF fracture management
May have intact blood supply to femoral head
May be possible to preserve the femoral head without AVN occurring
They can be treated with internal fixation (e.g., with screws) to hold the femoral head in place while the fracture heals.
Displaced intracapsular NOF fracture management
Grade 3 and 4 Garden classification
These disrupt blood supply so a hip replacement is needed
Choosing between hip replacement types
Hemiarthroplasty - generally for patients with limited mobility or significant co-morbidities
Total hip replacement (replacing both the head of the femur and the acetabulum):
- Generally offered to patients who can walk independently and are fit for surgery.
What are the classifications of extra-capsular fractures and how is each treated?
Intertrochanteric fractures
- Treat with dynamic hip screw
Subtrochanteric hip fractures:
- Distal to lesser trochanter (but within 5cm)
- Treat with intramedullary nail
NOF fracture presentation
Pain in the groin or hip, which may radiate to the knee
Not able to weight bear
Shortened, abducted and externally rotated leg
Investigations in suspected hip fracture and key findings suggesting this is the case
Hip X-ray - two views (AP and lateral)
- Likely to see disruption of Shenton’s line suggesting hip #
Management of hip fracture
Appropriate analgesia
Investigations to establish the diagnosis (e.g., x-rays)
Venous thromboembolism risk assessment and prophylaxis (e.g., low molecular weight heparin)
Pre-operative assessment (including bloods and an ECG) to ensure they are fit and optimised for surgery
Orthogeriatrics input
Surgery same day (within 48h)
Physiotherapy and early weight bearing after surgery
Post-op analgesia to help mobilisation
