HIp Fractures

Question 1

Hallmark of Hip Fx

Answer 1

GROIN PAIN

Question 2

Presentation of hip fx

Answer 2

thigh or knee pain - obturator n.
may or may not be able to bear weight
limb deformities - shortened and externally rotated
PE can make the fx worse - traversing from the intertrochanteric region toward the head might indicate more intense tx modality

Question 3

Log roll test

Answer 3

Dx of hip fx

GENTLY internally and externally rotate the leg - pain = positive = hip fx

Question 4

Tx of hip fx

Answer 4

depends on the fx relative to the joint capsule

Question 5

Intracapsular hip fx

Answer 5

all fx of the femoral neck

a. capital
b. subcapital- UNDER THE HEAD OF FEMUR
c. transvervical - across the neck of the femur
d. basicervical (baseo f the neck) - border of neck and intertrochanteric line

Question 6

extracapsular hip fx

Answer 6

basicervical
intertrochanteric- intertrochanteric line
subtrochanteric - in the proximal shaft

Question 7

fx of the femoral head

Answer 7

gun shot wound

high energy trauma

Question 8

what are the ligaments of the capsule?

Answer 8

iliofemoral ligament
pubofemoral ligament
ischiofemoral ligament

Question 9

Radiographic evaluations of the hip fx

Answer 9

orthogonal hip XR

AP is easy to get

Question 10

what is an occult hip fx?

Answer 10

can’t see the fx on XR

- do a MRI

Question 11

Garden classification of hip fx

Answer 11

Type I - incomplete or valgus impacted
Type II - complete non-displaced
Type III - complete partially displaced
Type IV - complete and completely displaced

Question 12

Tx of garden hip fx

Answer 12

depends on life or death of the femoral head

Question 13

Tx of type I and II

Answer 13

in situ pinning

head will live, thank god

Question 14

Tx of type III and IV

Answer 14

hemiarthroplasty - joint surface is replaced by artificial metal

medial circumflex is torn = AVN

Question 15

conservative Tx intracapsular fx

Answer 15

rarely indicated unlike in osteoarthritis
PROLONGED BEST REST AND TRACTION
not the usual tx

Question 16

Surgical tx of intracapsular fx

Answer 16

ORIF - open reduction and internal fixation
in situ pinning - percutaneous screw fixation for garden type I and II
hemiarthroplasty for garden type III and IV

Question 17

hemiarthroplasty vs arthroplasty

Answer 17

hemiarthroplasty-
not putting it in the acetabular cup
patients are allowed to bear weight immediately after surgery

Question 18

difference between hip fx vs femoral shaft fx

Answer 18

subtrochanteric fx falls in the shaft of the femur but it is considered part of the hip fx and not the femoral shaft fx

Question 19

hip fx is defined uniquely

Answer 19

PROXIMAL FEMUR FX
not femoral shaft fx
not acetabular fx

Question 20

Fixation of intertrochanteric fx

Answer 20

dynamic hip screw - a metal rod to side of the bone and nail it in
they will still have their bone/vasculature
-had intertrochanteric fx

cephalomedullary nail - IM Nail
rod right down the middle of the femur - sits on the lateral side of the bone and is nailed in from there - mechanical advantage with fixation closer to where load is

Question 21

Tx of subtrochanteric fx

Answer 21

same as intertrocheric fx
with DHS and IM nail
it will not result in non-unions or AVN

Question 22

DVT

Answer 22

big deal with any of the fx

require prophylaxis with low weight heparin