Hip fractures + femoral shaft fractures Flashcards
What are the two categories of hip fractures?
-
Intracapsular (subcapital and transcervical)
- Above the intertrochanteric line
- Especially if displaced, high risk of avascular necrosis
-
Extracapsular (intertrochanteric and subtrochanteric)
- Below the intertrochanteric line
Why is there a high risk of avascular necrosis in those with an intracapsular fracture?
- There is disruption of the retrograde blood supply
- The ligamentum teres (remnant of the foveal artery) then becomes the only blood supply to the head of the femur
How do most hip fractures occur?
- Elderly individuals with underlying osteoporosis following low energy trauma, such as a fall from standing
- Less often, hip fractures occur in younger individuals secondary to high energy trauma, such as a road traffic accident
Risk factors for hip fracture
-
Osteoporosis or osteopenia
- Post menopausal women
- Elderly
- Steroid use
- Low BMI
- Smoking and alcohol
- Falls: includes risk factors for falls, such as visual impairment and dementia
- Metastatic cancer: may results in pathological fracture
Clinical features of hip fracture
Symptoms
- Fall or trauma: most commonly a fall from standing
- Inability to weight bear
- Pain in the affected hip, groin or thigh
Signs
- Shortened and externally rotated leg
Investigations for hip fracture
- Plain radiographs: AP pelvis and lateral hip x-rays
-
Bloods
- FBC (anaemia may be present)
- U&Es (correct any abnormalities, may be rhabdomyloysis is long-lie after fall)
- Blood glucose (screen for hypoglycaemia as cause of fall)
- Coagulation screen (required peri-operatively)
- Group & save and cross match
- ECG (to assess for cardiogenic cause of fall)
What feature can you look at on an X-ray to see if there is a fracture?
Shenton’s line
No fracture
1) Yes
2) Left
3) Intracapsular
4) No
1) Yes
2) Right
3) Intracapsular
4) Yes
1) Yes
2) Right
3) Extracapsular
4) Displaced
Which classification is used to categorise intracapsular hip fractures?
What may be used as pain relief for a hip fracture?
Fascia iliaca block
Surgical management of hip fracture
-
Intracapsular
- Displaced
- Fit/young: total hip replacement
- Frail/old: hemi arthroplasty
- Non-displaced
- Canulated hip screws
- Displaced
-
Extracapsular
- Inter-trochanteric
- Dynamic hip screw
- Sub-trochanteric
- Intramedullary nail
- Inter-trochanteric
Prognosis of hip fracture
One year mortality is 30%
(Commonly due to complications such as thromboembolism and infections)
Femoral shaft fractures are most commonly seen in:
- High-energy trauma
- Fragility fractures in the elderly (low trauma)
- Pathological fractures (eg metastatic deposits, osteomalacia)
- Bisphosphonate-related fractures
Symptoms of femoral shaft fracture
- Pain in thigh and/or hip or knee pain
- Unable to bear weight
- In severe cases, obvious deformity
Femoral shaft fracture examination
- Assess the skin, which may be open or threatened
- Proximal fragment is invariably pulled into flexion and external rotation
- Full neurovascular examination
Investigations for femoral shaft fracture
- Bloods: including coagulation and group and save
- Plain film radiograph including an AP and lateral of the entire femur, including hip and knee
Management of femoral shaft fracture
- Adequate pain relief +/- regional blockade (fascia iliaca block)
- Immediate reduction and immobilisation (using in line traction)
- Should be surgically fixed within 24-48 hours
- antegrade intramedullary nail
