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MSK - my cards > Hip Fractures > Flashcards

Hip Fractures Flashcards

1
Q

Explain increased incidence of hip fractures in Scottish population:

A

Increased ageing population

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2
Q

Who is MOST likely to suffer a hip fracture?

A

Over 80 yo

Female (around 75% of hip # female)

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3
Q

What is the lifetime risk of hip fracture for males and females for >50s?

A

Male 5-10%

Female 15-20%

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4
Q

Cost of treatment per patient per year?

A

> £12500 per patient per year

>£73 million per year in Scotland alone

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5
Q

When patient falls, causing hip fracture, what could be the cause?

A 
Cerebrovasuclar disease
Cardiac arrhythmia
Potural hyotension
Mechanical Fall
(usually no obvious organic cause falls)
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6
Q

What condition of the bones makes a hip fracture more likely?

A

Osteoporosis

age related, qualitative defect of bone, more common in females, may be related to smoking, alcohol or steroids

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7
Q

What are the risks of motality after a hip fracture after 1 month, 3 months and 1 year?

A

1 month - 10%
3 months - 20%
1 year - 30%

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8
Q

How are vast majority treated?

A

Surgery

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9
Q

What are risks of not operating on hip fracture?

A

Prolonged bed rest - risks
Very painful
Surgery gives best chance of patient returning home
Only patients with very severe co-morbidities (expected to die) are not operated on

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10
Q

If patient lives independantly, what are the risks of requiring institutional care post-hip #?

A

20% risk of requiring institutional care

residential home, nursing home

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11
Q

What surgical complications are associated?

A 
Failure of fixation
AVN (avascular necrosis)
Non-union ( when a broken bone fails to heal)
Infection (5%)
Dislocation
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12
Q

Which clinical features suggest a hip fracture?

A 
Limb shortening
External rotation
Trochanteric bruising
Unable to SLR (straight leg raise)
Severe groin pain or rotational movements
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13
Q

What two muscles are attached (laterally) to the hip? (gluteus..)

A 
Gluteus medius (larger)
Gluteus minimus
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14
Q

What muscle attaches the femur to the spine?

A

Illiopsoas psoas (major)

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15
Q

What muscle attaches the femur to the ilium?

A

Illiopsoas illacus

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16
Q

What muscle attachments are involved in the hip joint?

A

Gluteus medius
Gluteus minimus

Illiopsoas psoas major (minor attached)
Illipsoas iliacus

Adductor magnus
Adductor brevis
Adductor longus
Gracilis (attaches to medial surface of tibia)

Pectineus

Sartorius

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17
Q

Which (branch of which) artery is the main blood supply to head of femur?

A

Branch from obturator artery ( which is a branch of internal iliac artery)

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18
Q

Which branch of the circumflex arteries gives off the retinacular arteries?

A

Medial

(medial and lateral circumflex arteries –> medial branch gives off retinacular arties –> retinacular arteries supply hip joint)

19
Q

Which arteries supply most of the blood supply to the hip joint?

A

Retinacular arteries

given off from medial circumflex branch

20
Q

What is the other name for zona obicularis?

A

Annular ligament

21
Q

Which ligments are in the hip capsule?

4

A 
Illiofemoral ligament (anterior and posterior)
Pubofemoral ligament (anterior)
Ischiofemoral ligament (posterior)
Zone obicularis (annular ligament) (posterior)
22
Q

What is the 5cm area inferior to the transtrocharteric area classified as?

A

Subtrocharteric area

23
Q

What area is the neck of he femur classified as?

A

Intracapsular

24
Q

What is the area between the intracapsular area and the subtrochanteric area classified as?

A

Extracapsular

25
Q

How do you investigate hip fracture?

A

X-ray

MRI for occult fractures

26
Q

Why is it so important to get hip operation right the first time?

A

Elderly patients may not survive second operation and functionally deteriorate

27
Q

Which gives better function, a total replacement or a hemiarthroplasty?

A

Total Hip Replacement

THR gives higher function than hemiarthroplasty but there is a higher dislocation rate

28
Q

When would you do hemiarthroplasty instead of total replacement?

A

In those with poorer function or cognitive defect.

hemiarthroplasty just replaces head of femur, only half of the hip joint is replaced, not the whole joint

29
Q

When may you consider FIXATION (rather than replacement)?

A

In undisplaced fractures and intracapsular fractures if younger and fitter patient (<60)

30
Q

What type of surgery is most reliable for intracapsular fractures?

A

Replacement

31
Q

Do extracapsular fractures pose a risk of AVN?

A

no

32
Q

What usually causes healing of extracapsular fractures?

A

Sliding hip screw (dynamic hip screw (DHS))

Can also fix with intramedullary nail and sliing hip screw (less lever arm)

33
Q

What does success of fixation of extracapsular fractures depend on?

A

Quality of reduction and centrality of screws in head

also, uncreased number of parts –> increased instability and increased failure rates

34
Q

In a subtrochanteric fracture, what gives a higher risk of non-union?

A

If the blood suppl to the fracture site isn’t as good

35
Q

Long-term use of which type of drugs has been linked to incidence of subtrochanteric fractures?

A

Bisphosphonate use

used to slow down or prevent bone damage

36
Q

Why is an intramedullary nail (IM nail) superior?

A

May last longer before breakage if delayed union

37
Q

How is a pubic rami fracture different from high energy pelvic fracture?

A

N major displacement and bleeding in pubic rami fracture

38
Q

What are the symptoms of a pubic rami fracture?

A

Tender groin

less pain on rotation than hip #

39
Q

Management of greater trochanter fracture?

A

Usually conservative management

Can get MRI –> to see if fracture traverses femoral neck –> if so –> internal fixation

40
Q

Prevention of future hip fractures:

A

Exercise may help maintain muscle strength and bone mineral density.

(Falls clinic, anti-resoptive drigs for osteoporosis, hip protectors may be used -> ALL NO PROVEN BENEFIT)

41
Q

How may you treat Intracepsular fracture in younger patient?

A

Fixation

42
Q

How may you treat Intracepsular fracture if undisplaced?

A

Fixation

43
Q

How do you fix extracapsular fracture?

A

Dynamic Hip Screw (DHS)

MSK - my cards (13 decks)

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