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Orthopaedics r > Hip fractures > Flashcards

Hip fractures Flashcards

1
Q

name 4 differentials for hip pain in adults

A
  • trochanteric bursitis
  • osteoarthritis
  • referred lumbar spine pain
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2
Q

what is referred lumbar spine pain

A

femoral nerve compression causing referred pain in the hip

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3
Q

What is trochanteris bursitis and what causes it?

A

Due to repeated movement of fibroelastic, the capsule becomes inflamed and causes pain and tenderness over the lateral side of the thigh

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4
Q

what age group does trochanteric bursitis typically occur in?

A

50-70 year olds

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5
Q

name 3 causes of avascular necrosis of the femoral head

A
  • hip fracture
  • hip dislocation
  • high dose steroid therapy
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6
Q

what are the features of osteoarthritis of the hip

A

chronic history of groin ache following exercise and relieved by rest

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7
Q

management of osteoarthritis of hip?

A
  • oral analgesia
  • intra-articular injections
  • total hip replacement is definitive
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8
Q

what is the definition of osteoporosis?

A

Bone mineral density of < 2.5 standard deviations below the young adult mean density

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9
Q

How is bone mineral density calculated?

A

DEXA scan

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10
Q

what does a T score of -1.0 mean>

A

bone mineral density of 1 standard deviation below that of young reference population

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11
Q

Management of osteoporosis?

A
  • vitamin D supplements
  • Calcium supplements
  • Alenronate
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12
Q

what is Alendronate?

A

Bisphosphonate that inhibits the action of osteoclasts

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13
Q

how often are alendronate tablets taken?

A

once daily or once weekly

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14
Q

when are alendronate tablets taken? and how?

A

first thing in the morning when wake up and before eaten or drunk anything (besides water), take with a large glass of water, standing/sitting in an upright position
and
do not eat/drink anything for the following 30 minutes and take separately from taking other medications as they may affect the absorption

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15
Q

what are the side effects of alendronate

A

indigestion, abdo pain, nausea, vomiting, diarrhoea, constipation, headache, dizziness

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16
Q

what is the blood supply to the femoral head?

A

Medial circumflex femoral artery

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17
Q

what are the 2 types of hip fractures

A

intra capsular
and
extra capsular

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18
Q

what are the 2 types of intra capsular fractures

A

displaced and not displaced

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19
Q

What does Garden classification 1 + 2 indicate and how should they be managed?

A

non displacement of the intracapsular hip fracture

managed by fixing e.g. screws

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20
Q

What does garden classification 3 + 4 indicate and how should they be managed?

A

displacement of the intracapsular fracture

managed by hemi-arthroplasty or total arthroplasty

21
Q

how does septic arthritis present?

A

single, hot, swollen, tender joint

22
Q

joint aspiration should include which investigations when ?diagnosis of septic arthritis

A
  • drain pus
  • gram stain
  • microscopy
  • culture
23
Q

how should a swollen prosthetic joint be managed?

A

aspirated in theatre

24
Q

what is the likely causative bacteria causing a septic prosthetic joint?

A

staph or strep

25
Q

what is the abx management of septic arthritis

A

Flucloxacillin IV 4-6 weeks

26
Q

what abx to give if MRSA is suspected cause of septic arthritis

A

Vancomycin

27
Q

what bacteria is associated with sickle cell anaemia patients as a cause of osteomyelitis?
and what is the management?

A

salmonella

Flucloxacillin/Clindamycin +/- rifampicin

IV abx for 6 weeks

28
Q

what is the most common paediatric elbow fracture?

and what is the mechanism of injury?

A

supracondylar fracture

fall on hyperextended elbow

29
Q

what is the blood supply to the femoral head?

A

medial & lateral circumflex arteries

30
Q

what is the 4 types of Gardener classification for intra-capsular fractures?

A

Type 1 = incomplete, impacted valgus

Type 2 = complete fracture - non displaced

Type 3 = complete fracture, partially displaced

Type 4 = complete fracture, completely displaced

31
Q

hip fracture risk factors

A
  • age
  • osteoporosis
  • low muscle mass
  • steroids
  • smoking
  • alochol
  • mets
32
Q

what is shentons line

A

the line drawn from the inferior ramus across and down along the inferomedial border of neck of femur - should be smoooth

33
Q

treatment of non displaced intracapsular fractures? (Garden 1/2)

A

internal fixation with 2/3 screws

34
Q

treatment of displaced intracapsular fractures? (Garden 3/4)

A

total hip replacement or hemi-arthroplasty

35
Q

who should total hip replacement be offered to?

A

Displaced intracapsular hip fractures (Garden 3/4)
&
- able to walk independently out of doors with no more than the use of stick
- not cognitively impaired
- medically fit for anaesthesia & procedure1

36
Q

where is the location of fracture in intracapsular fractures?

A

from the edge of the femoral head to the insertion of the capsule @ the hip joint

37
Q

where is the location of fracture in an extracapsular fracture

A

trochanteric or subtrochanteric

38
Q

management of extracapsular hip fracture?

A
  • DHS (dynamic hip screw)

or intramedullary device; if xyz

39
Q

score used to assess function and pain with patients undergoing hip replacement surgery

A

oxford hip score

40
Q

features of hip OA

A

chronic history of groin ache followinf exercise and relieved with rest

41
Q

management of Hip OA

A
  • oral analgesia
  • intra articular injections
  • total hip replacement is definitive treatment
42
Q

screening tool used to assess the 10 year risk of patient developing a fragility fracture?

A

FRAX

43
Q

what scan assess actual bone denisty?

A

DEXA

44
Q

DEXA score of -1.0 to -2.5 is

A

osteopaeniaa

45
Q

what DEXA score equates to osteoporosis

A

< -.25

46
Q

mechanism of alendronic acid

A

inhibits action of osteoclasts

47
Q

how would you explain to a patient how alendronic acid works?

A

slows down the rate at which bone is being broken down

48
Q

when should you take alendronic acid?

A

first thing in the morning before eating/drinking anythign, with a large glass of water
& continue to stand for following 30 minutes

Orthopaedics r (10 decks)

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