Hip fractures Flashcards
name 4 differentials for hip pain in adults
- trochanteric bursitis
- osteoarthritis
- referred lumbar spine pain
what is referred lumbar spine pain
femoral nerve compression causing referred pain in the hip
What is trochanteris bursitis and what causes it?
Due to repeated movement of fibroelastic, the capsule becomes inflamed and causes pain and tenderness over the lateral side of the thigh
what age group does trochanteric bursitis typically occur in?
50-70 year olds
name 3 causes of avascular necrosis of the femoral head
- hip fracture
- hip dislocation
- high dose steroid therapy
what are the features of osteoarthritis of the hip
chronic history of groin ache following exercise and relieved by rest
management of osteoarthritis of hip?
- oral analgesia
- intra-articular injections
- total hip replacement is definitive
what is the definition of osteoporosis?
Bone mineral density of < 2.5 standard deviations below the young adult mean density
How is bone mineral density calculated?
DEXA scan
what does a T score of -1.0 mean>
bone mineral density of 1 standard deviation below that of young reference population
Management of osteoporosis?
- vitamin D supplements
- Calcium supplements
- Alenronate
what is Alendronate?
Bisphosphonate that inhibits the action of osteoclasts
how often are alendronate tablets taken?
once daily or once weekly
when are alendronate tablets taken? and how?
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
what are the side effects of alendronate
indigestion, abdo pain, nausea, vomiting, diarrhoea, constipation, headache, dizziness
what is the blood supply to the femoral head?
Medial circumflex femoral artery
what are the 2 types of hip fractures
intra capsular
and
extra capsular
what are the 2 types of intra capsular fractures
displaced and not displaced
What does Garden classification 1 + 2 indicate and how should they be managed?
non displacement of the intracapsular hip fracture
managed by fixing e.g. screws
What does garden classification 3 + 4 indicate and how should they be managed?
displacement of the intracapsular fracture
managed by hemi-arthroplasty or total arthroplasty
how does septic arthritis present?
single, hot, swollen, tender joint
joint aspiration should include which investigations when ?diagnosis of septic arthritis
- drain pus
- gram stain
- microscopy
- culture
how should a swollen prosthetic joint be managed?
aspirated in theatre
what is the likely causative bacteria causing a septic prosthetic joint?
staph or strep
what is the abx management of septic arthritis
Flucloxacillin IV 4-6 weeks
what abx to give if MRSA is suspected cause of septic arthritis
Vancomycin
what bacteria is associated with sickle cell anaemia patients as a cause of osteomyelitis?
and what is the management?
salmonella
Flucloxacillin/Clindamycin +/- rifampicin
IV abx for 6 weeks
what is the most common paediatric elbow fracture?
and what is the mechanism of injury?
supracondylar fracture
fall on hyperextended elbow
what is the blood supply to the femoral head?
medial & lateral circumflex arteries
what is the 4 types of Gardener classification for intra-capsular fractures?
Type 1 = incomplete, impacted valgus
Type 2 = complete fracture - non displaced
Type 3 = complete fracture, partially displaced
Type 4 = complete fracture, completely displaced
hip fracture risk factors
- age
- osteoporosis
- low muscle mass
- steroids
- smoking
- alochol
- mets
what is shentons line
the line drawn from the inferior ramus across and down along the inferomedial border of neck of femur - should be smoooth
treatment of non displaced intracapsular fractures? (Garden 1/2)
internal fixation with 2/3 screws
treatment of displaced intracapsular fractures? (Garden 3/4)
total hip replacement or hemi-arthroplasty
who should total hip replacement be offered to?
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
where is the location of fracture in intracapsular fractures?
from the edge of the femoral head to the insertion of the capsule @ the hip joint
where is the location of fracture in an extracapsular fracture
trochanteric or subtrochanteric
management of extracapsular hip fracture?
- DHS (dynamic hip screw)
or intramedullary device; if xyz
score used to assess function and pain with patients undergoing hip replacement surgery
oxford hip score
features of hip OA
chronic history of groin ache followinf exercise and relieved with rest
management of Hip OA
- oral analgesia
- intra articular injections
- total hip replacement is definitive treatment
screening tool used to assess the 10 year risk of patient developing a fragility fracture?
FRAX
what scan assess actual bone denisty?
DEXA
DEXA score of -1.0 to -2.5 is
osteopaeniaa
what DEXA score equates to osteoporosis
< -.25
mechanism of alendronic acid
inhibits action of osteoclasts
how would you explain to a patient how alendronic acid works?
slows down the rate at which bone is being broken down
when should you take alendronic acid?
first thing in the morning before eating/drinking anythign, with a large glass of water
& continue to stand for following 30 minutes
