Hip Fractures Flashcards
What is a hip fracture?
A fracture in the upper 1/4 of the femur.
-within 5cm of distal lesser trochanter
How are hip fractures classified? (5)
By location:
- Subcapital
- Transcervical
- Basicervical
- Intertrochanteric
- Subtrochanteric
What are intracapsular fractures?
Fractures between the femoral neck and intertrochanteric line.
-Subcapital, transcervical & basicervical
What is the main blood supply to the femoral head?
Trochanteric anastomoses.
-nutrient arteries beneath capsule
Which arteries join to form the trochanteric anastomosis?
Inf/sup and med/lat femoral circumflex arteries.
A branch from which artery also provides a small contribution to the femoral head?
A branch of the obturator artery.
-runs along ligamentum teres
What can happen to the blood supply of the femoral head if it is fractured/displaced?
Retinacular and nutrient vessels may be torn»_space; avascular necrosis.
Which arteries join to form the retinacular vessels?
Medial and lateral femoral circumflex arteries.
What does the cruciate anastamosis supply?
Trochanteric area and upper femur.
What is the mean age for a hip fracture?
84 years old.
What proportion of hip fractures are in over 65s?
87%.
Are hip fractures more common in men or women?
3x more likely in females.
What are the main causes of hip fractures? (2)
- Simple fall (» fragility fracture)
- Rotational force on hip (without trauma)
What are the main risk factors of hip fractures?
AGING
»Osteoporosis
»Falls
If due to low impact trauma, what normally leads to hip fracture?
Underlying bone condition.
What underlying bone condition may lead to hip fractures? (5)
- OSTEOPOROSIS (most common)
- OSTEOMALACIA (vit. D deficiency)
- BONE METASTASES
- HAEMATOLOGICAL MALIGNANCY
- PAGET’S DISEASE
How do hip fractures commonly present?
- Fall
- Pain (groin/thigh/knee)
- Difficulty weight bearing
- Deformity
What are common deformities if hip fractures are displaced? (2)
- Shortened limb
- Externally rotated
What is the main nerve supply to the hip?
Anterior division of the obturator nerve.
Why is there often referred pain to the knee?
Posterior division of the obturator nerve supplies the knee.
What do previous fractures suggest?
Osteoporosis.
What are possible causes of falls?
- Acute medical illness
- Cardiac related
- Medication/alcohol related
- Cognitive impairment
How do undisplaced legs present?
Look normal, but especially painful on internal and external rotation.
What is rhabdomyolysis?
The destruction of striated muscle cells.
What is often tested after a hip fracture to measure rhabdomyolysis?
Creatine kinase.
-enzyme released during muscle damage
How soon should surgery be performed if the patient is medically stable?
Within 36 hours.
What is thromboprophylaxis, and when is it given?
Prevent of thromboembolic disease (e.g. DVT).
-given before surgery
How are intracapsular fractures treated surgically?
Replacement hemiarthroplasty.
What is hemiarthroplasty, and when is it normally performed?
Head of femur surgically replaced (stem of femur cemented and screws in acetabulum to stabilise).
-When blood supply is disrupted
How are extracapsular fractures generally treated?
- Dynamic hip screws
- Cannulated screws
How are impacted or undisplaced fractures treated?
Management/supportative.
-no surgery required
What treatment is generally given perioperatively (before/during/after)?
- Antibiotics
- MRSA prophylaxis
- Thromboprophylaxis
How are patients managed post-operatively?
- Monitor fluid and nutrition
- Early mobilisation important
- Prevent further falls
- Prevent further fractures
How are further fractures prevented?
- Treat osteoporosis
- Vitamin D replacement
How is osteoporosis treated?
- Biphosphonates
- Denosumab
- Teriparitide
What are possible complications after surgery? (5)
- Wound infections
- Thromboembolisms (DVT, PE)
- Bronchopneumonia
- UTI
- Malnutrition
When was the National Hip Fracture Database launched?
2007.
What is the purpose of the National Hip Fracture Database?
Allows trust to analyse patient outcomes and performances.
What are the features of the Best Practice Tariff?
- Surgery within 36hrs
- Cognitive assessment
- Orthogeriatrician involvement
- Falls and bone health assessment
- Delirium assessment (7 days)
What sort of rehabilitation should be provided?
Geriatrician-led rehabilitation.
What proportion of patients die within 30 days?
~7%.
What proportion of patients die within 1 year?
~33%.
What proportion of >90 year olds die within 30 days?
~30%.
