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Year 2 C&M symposia > Hip Fractures > Flashcards

Hip Fractures Flashcards

1
Q

What is a hip fracture?

A

A fracture in the upper 1/4 of the femur.

-within 5cm of distal lesser trochanter

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2
Q

How are hip fractures classified? (5)

A

By location:

  • Subcapital
  • Transcervical
  • Basicervical
  • Intertrochanteric
  • Subtrochanteric
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3
Q

What are intracapsular fractures?

A

Fractures between the femoral neck and intertrochanteric line.
-Subcapital, transcervical & basicervical

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4
Q

What is the main blood supply to the femoral head?

A

Trochanteric anastomoses.

-nutrient arteries beneath capsule

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5
Q

Which arteries join to form the trochanteric anastomosis?

A

Inf/sup and med/lat femoral circumflex arteries.

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6
Q

A branch from which artery also provides a small contribution to the femoral head?

A

A branch of the obturator artery.

-runs along ligamentum teres

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7
Q

What can happen to the blood supply of the femoral head if it is fractured/displaced?

A

Retinacular and nutrient vessels may be torn&raquo_space; avascular necrosis.

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8
Q

Which arteries join to form the retinacular vessels?

A

Medial and lateral femoral circumflex arteries.

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9
Q

What does the cruciate anastamosis supply?

A

Trochanteric area and upper femur.

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10
Q

What is the mean age for a hip fracture?

A

84 years old.

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11
Q

What proportion of hip fractures are in over 65s?

A

87%.

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12
Q

Are hip fractures more common in men or women?

A

3x more likely in females.

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13
Q

What are the main causes of hip fractures? (2)

A
  • Simple fall (» fragility fracture)

- Rotational force on hip (without trauma)

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14
Q

What are the main risk factors of hip fractures?

A

AGING
»Osteoporosis
»Falls

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15
Q

If due to low impact trauma, what normally leads to hip fracture?

A

Underlying bone condition.

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16
Q

What underlying bone condition may lead to hip fractures? (5)

A
  • OSTEOPOROSIS (most common)
  • OSTEOMALACIA (vit. D deficiency)
  • BONE METASTASES
  • HAEMATOLOGICAL MALIGNANCY
  • PAGET’S DISEASE
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17
Q

How do hip fractures commonly present?

A
  • Fall
  • Pain (groin/thigh/knee)
  • Difficulty weight bearing
  • Deformity
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18
Q

What are common deformities if hip fractures are displaced? (2)

A
  • Shortened limb

- Externally rotated

19
Q

What is the main nerve supply to the hip?

A

Anterior division of the obturator nerve.

20
Q

Why is there often referred pain to the knee?

A

Posterior division of the obturator nerve supplies the knee.

21
Q

What do previous fractures suggest?

A

Osteoporosis.

22
Q

What are possible causes of falls?

A
  • Acute medical illness
  • Cardiac related
  • Medication/alcohol related
  • Cognitive impairment
23
Q

How do undisplaced legs present?

A

Look normal, but especially painful on internal and external rotation.

24
Q

What is rhabdomyolysis?

A

The destruction of striated muscle cells.

25
Q

What is often tested after a hip fracture to measure rhabdomyolysis?

A

Creatine kinase.

-enzyme released during muscle damage

26
Q

How soon should surgery be performed if the patient is medically stable?

A

Within 36 hours.

27
Q

What is thromboprophylaxis, and when is it given?

A

Prevent of thromboembolic disease (e.g. DVT).

-given before surgery

28
Q

How are intracapsular fractures treated surgically?

A

Replacement hemiarthroplasty.

29
Q

What is hemiarthroplasty, and when is it normally performed?

A

Head of femur surgically replaced (stem of femur cemented and screws in acetabulum to stabilise).
-When blood supply is disrupted

30
Q

How are extracapsular fractures generally treated?

A
  • Dynamic hip screws

- Cannulated screws

31
Q

How are impacted or undisplaced fractures treated?

A

Management/supportative.

-no surgery required

32
Q

What treatment is generally given perioperatively (before/during/after)?

A
  • Antibiotics
  • MRSA prophylaxis
  • Thromboprophylaxis
33
Q

How are patients managed post-operatively?

A
  • Monitor fluid and nutrition
  • Early mobilisation important
  • Prevent further falls
  • Prevent further fractures
34
Q

How are further fractures prevented?

A
  • Treat osteoporosis

- Vitamin D replacement

35
Q

How is osteoporosis treated?

A
  • Biphosphonates
  • Denosumab
  • Teriparitide
36
Q

What are possible complications after surgery? (5)

A
  • Wound infections
  • Thromboembolisms (DVT, PE)
  • Bronchopneumonia
  • UTI
  • Malnutrition
37
Q

When was the National Hip Fracture Database launched?

A

2007.

38
Q

What is the purpose of the National Hip Fracture Database?

A

Allows trust to analyse patient outcomes and performances.

39
Q

What are the features of the Best Practice Tariff?

A
  • Surgery within 36hrs
  • Cognitive assessment
  • Orthogeriatrician involvement
  • Falls and bone health assessment
  • Delirium assessment (7 days)
40
Q

What sort of rehabilitation should be provided?

A

Geriatrician-led rehabilitation.

41
Q

What proportion of patients die within 30 days?

A

~7%.

42
Q

What proportion of patients die within 1 year?

A

~33%.

43
Q

What proportion of >90 year olds die within 30 days?

A

~30%.

Year 2 C&M symposia (11 decks)

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