Hip Fractures

Question 1

what group of people are hip fractures most often seen in

Answer 1

92% cases in >60s, 73% females

Question 2

how can young people suffer hip fractures

Answer 2

from high energy trauma

Question 3

what risk factors are associated with hip fractures

Answer 3

increasing age, osteoporosis, smoking, malnutrition, excess alcohol, neurological impairment, low BMI

Question 4

describe how age is associated with hip fracture risk

Answer 4

risk doubles every 10 years after 50

Question 5

describe the anatomical position of intracapsular hip fractures

Answer 5

proximal to greater and lesser trochanter, but distal to femoral head
(femoral neck more or less)

Question 6

describe the anatomical position of extracapsular hip fractures

Answer 6

distal to line from greater to lesser trochanter, up to 5cm below lesser trochanter

Question 7

describe the blood supply to the femoral head

Answer 7

intramedullary artery of shaft of femur, medial + lateral circumflex branches of profunda femoris, artery of ligamentum teres

Question 8

in terms of blood supply what is the difference between intra and extracapsular hip fractures

Answer 8

intracapsular cuts of blood supply to femoral head, whereas extracapsular doesn’t

Question 9

what problem can intracapsular fractures result in the femoral head

Answer 9

avascular necrosis(AVN)

Question 10

what different types of intracapsular fractures are there

Answer 10

subcapital or transcervical, can both be either displaced or undisplaced

Question 11

describe the difference between a subcapital and transcervical hip fracture

Answer 11

subcapital much closer to femoral head, transcervical in the middle of the femoral neck

Question 12

what classification is used for intracapsular hip fractures

Answer 12

Garden I to IV, graded by size of fracture and displacement

Question 13

what different types of extracapsular hip fractures are there

Answer 13

basicervical, intertrochanteric, reverse oblique, subtrochanteric

Question 14

describe where is a basicervical hip fracture

Answer 14

at the base of the femoral neck, just above the greater and lesser trochanters

Question 15

describe where an intertrochanteric and subtrochanteric hip fracture is seen

Answer 15

intertrochanteric = going through the greater and lesser trochanters
subtrochanteric = below lesser trochanter, at very proximal end of femoral shaft

Question 16

what is looked for/seen in the physical examination of hip fracture patients

Answer 16

unable to weight bear, pain, cognitive impairment?, missed injuries fluid stats/dehydration, examination of limb

Question 17

what is involved in the physical examination of the limb of a hip fracture patient

Answer 17

neurological status, vascular status, leg may be shortened and externally rotated

Question 18

what bedside tests are done for hip fracture patients

Answer 18

ECG, bloods

Question 19

what investigations are done to diagnose hip fracture

Answer 19

X-ray of pelvis and lateral hip, if in doubt MRI

Question 20

describe what Shenton’s line is

Answer 20

an anatomical line formed by the medial edge of the femoral neck and the inferior edge of the superior ramus

Question 21

what is the clinical relevance of Shenton’s line

Answer 21

loss of contour of the line is a sign pf neck of femur fracture
(although not always)