Hip Fractures Flashcards
Explain increased incidence of hip fractures in Scottish population:
Increased ageing population
Who is MOST likely to suffer a hip fracture?
Over 80 yo
Female (around 75% of hip # female)
What is the lifetime risk of hip fracture for males and females for >50s?
Male 5-10%
Female 15-20%
Cost of treatment per patient per year?
> £12500 per patient per year
>£73 million per year in Scotland alone
When patient falls, causing hip fracture, what could be the cause?
Cerebrovasuclar disease Cardiac arrhythmia Potural hyotension Mechanical Fall (usually no obvious organic cause falls)
What condition of the bones makes a hip fracture more likely?
Osteoporosis
age related, qualitative defect of bone, more common in females, may be related to smoking, alcohol or steroids
What are the risks of motality after a hip fracture after 1 month, 3 months and 1 year?
1 month - 10%
3 months - 20%
1 year - 30%
How are vast majority treated?
Surgery
What are risks of not operating on hip fracture?
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
If patient lives independantly, what are the risks of requiring institutional care post-hip #?
20% risk of requiring institutional care
residential home, nursing home
What surgical complications are associated?
Failure of fixation AVN (avascular necrosis) Non-union ( when a broken bone fails to heal) Infection (5%) Dislocation
Which clinical features suggest a hip fracture?
Limb shortening External rotation Trochanteric bruising Unable to SLR (straight leg raise) Severe groin pain or rotational movements
What two muscles are attached (laterally) to the hip? (gluteus..)
Gluteus medius (larger) Gluteus minimus
What muscle attaches the femur to the spine?
Illiopsoas psoas (major)
What muscle attaches the femur to the ilium?
Illiopsoas illacus
What muscle attachments are involved in the hip joint?
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
Which (branch of which) artery is the main blood supply to head of femur?
Branch from obturator artery ( which is a branch of internal iliac artery)
Which branch of the circumflex arteries gives off the retinacular arteries?
Medial
(medial and lateral circumflex arteries –> medial branch gives off retinacular arties –> retinacular arteries supply hip joint)
Which arteries supply most of the blood supply to the hip joint?
Retinacular arteries
given off from medial circumflex branch
What is the other name for zona obicularis?
Annular ligament
Which ligments are in the hip capsule?
4
Illiofemoral ligament (anterior and posterior) Pubofemoral ligament (anterior) Ischiofemoral ligament (posterior) Zone obicularis (annular ligament) (posterior)
What is the 5cm area inferior to the transtrocharteric area classified as?
Subtrocharteric area
What area is the neck of he femur classified as?
Intracapsular
What is the area between the intracapsular area and the subtrochanteric area classified as?
Extracapsular
How do you investigate hip fracture?
X-ray
MRI for occult fractures
Why is it so important to get hip operation right the first time?
Elderly patients may not survive second operation and functionally deteriorate
Which gives better function, a total replacement or a hemiarthroplasty?
Total Hip Replacement
THR gives higher function than hemiarthroplasty but there is a higher dislocation rate
When would you do hemiarthroplasty instead of total replacement?
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
When may you consider FIXATION (rather than replacement)?
In undisplaced fractures and intracapsular fractures if younger and fitter patient (<60)
What type of surgery is most reliable for intracapsular fractures?
Replacement
Do extracapsular fractures pose a risk of AVN?
no
What usually causes healing of extracapsular fractures?
Sliding hip screw (dynamic hip screw (DHS))
Can also fix with intramedullary nail and sliing hip screw (less lever arm)
What does success of fixation of extracapsular fractures depend on?
Quality of reduction and centrality of screws in head
also, uncreased number of parts –> increased instability and increased failure rates
In a subtrochanteric fracture, what gives a higher risk of non-union?
If the blood suppl to the fracture site isn’t as good
Long-term use of which type of drugs has been linked to incidence of subtrochanteric fractures?
Bisphosphonate use
used to slow down or prevent bone damage
Why is an intramedullary nail (IM nail) superior?
May last longer before breakage if delayed union
How is a pubic rami fracture different from high energy pelvic fracture?
N major displacement and bleeding in pubic rami fracture
What are the symptoms of a pubic rami fracture?
Tender groin
less pain on rotation than hip #
Management of greater trochanter fracture?
Usually conservative management
Can get MRI –> to see if fracture traverses femoral neck –> if so –> internal fixation
Prevention of future hip fractures:
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)
How may you treat Intracepsular fracture in younger patient?
Fixation
How may you treat Intracepsular fracture if undisplaced?
Fixation
How do you fix extracapsular fracture?
Dynamic Hip Screw (DHS)
