Hip fractures

Question 1

Intracapsular fracture in young person

Answer 1

Undisplaced -> internal fixation

Displaced -> internal fixation(/total hip replacement)

Question 2

Intracapsular fracture in old person

Answer 2

Displaced -> Mobile with 1 stick or better AND no cognitive impairment AND medically fit for anaesthetic and procedure -> yes - total hip replacement; no - hemiarthroplasty

Undiplaced -> Mobile with 1 stick or better AND no cognitive impairment AND medically fit for anaesthetic and procedure -> yes - total hip replacement/internal fixation; no hemiarthroplasty

Question 3

Extracapsular hip fracture

Answer 3

Subtrochanteric -> intramedullary nail
Reverse oblique (type of pertrochanteric fracture) -> intramedullary nail
Unstable intertrochanteric -> intramedullary nail or dynamic hip screw
Stable intertrochanteric -> dynamic hip screw

Question 4

How do you assess intertrachanteric hip fracture stability?

Answer 4

If the trochanter (and therefore lateral wall), and medial calcar is in tact, then the fracture configuration bears stability.
Where either or both structures are involved in the fracture, stability becomes compromised and many surgeons will favour using an intramedullary device.