Hip fractures

Question 1

What are the types of femoral head fracture

Answer 1

Defined by location compared to the capsule -as the blood supply to the capsule (intracapsular) is weak and often lost in frax
displaced frax = high risk of avascular necrosis

Intracapsular- edge of head to capsule insertion
Extracapsular- trochanteric or subtrochanteric

GARDEN classification
1- stable
2- complete but undisplaced
3- displaced
iv- no bone contact
worse blood in 3/4

Question 2

What are the presentation of NOF fracture

Answer 2

very common
Think old lady with low energy fall
+ pain, shortened and externally rotated leg
little frax- can still weight bear

Question 3

Management of NOF fracture

Answer 3

Intracapsular-
Hemiarthroplasty is the method of choice if the patient is IMMOBILE/going to die soon-doesnt need such a good joint
Total Arthroplasty if mobile and needs a functioning hip after./is gonna die in a while

Extracapsular frax= dynamic hip screw
if more in the shaft (subtrochanteric)- can use intramedullary device (inserted in the bone)

Question 4

What are pelvis fractures

Answer 4

RARE due to trauma - crushing
In healthy people- always 2 frax - as one side has to give
in older- can be 1 sided as bone crunch up

Question 5

Signs and Ix of pelvis fractures

Answer 5

Pain and inability to weight bear after trauma
Exam-can gently try and rotate the illiac crest - can move if frax
External rotation of legs
limb-length discrepency
Neurol issues- L5 and S1 most common
anal tone

ix=AP pelvis view, flamingo pelvis view

alwways check for blood pooling in pelvis after trauma- hidden bleeds

Question 6

Management of pelvis fractures

Answer 6

Ressus/etc if needed

pelvic binder/sheet are the common method
external fixation

Question 7

What are pubic rami fractures

Answer 7

Fracture of the rami of pubic bone often due to trauma

will heal on its own with painkillers and monitoring