Hip Trauma

Question 1

Femoral neck fracture

• common in
• presentation
• types
• Xray findings

Answer 1

Osteoporotic, elderly females

Pain
Short, flexed, laterally rotated leg
Non displaced/incomplete # may be able to weight bear

Intracapsular => avascular necrosis risk
Extracapsular => if under lessor trochanter

Shenton’s line

Question 2

Femoral neck fracture
-Garden system for classification

Management for intracapsular

• undisplaced
• displaced

Management for extracapsular

Answer 2

1-impacted
2-not displaced
3-displaced bony contact (blood supply disrupted)
4-total bony displacement (blood supply disrupted)

Orthogeriatric referral
Analgesia, blocks, fluids

Intracapsular undisplaced
-internal fixation/HAP

Intracapsular displaced

• THR if independently mobile with only a stick, no cognitive impairment, medically fit for anaesthesia and surgery
• HAP if not

Extracapsular

• if stable intertrochanteric # => DHS
• everything else => IMD
• if

Question 3

Fractured femur shaft

• common in
• presentation
• immediate management

Answer 3

High energy - young, RTAs
Low energy - elderly falls

Immediate severe pain
Can’t weight bear
Shorter, not straight

Check neurovascular status
IV fluids, G&S for blood loss
Analgesia, traction splint

Question 4

Fractured femur shaft

-management - DEFINITIVE AND SUPPORTIVE

Answer 4

Surgical fixation - IMD

• can be delayed until other life threatening conditions stabilised
• ABx for open fractures

Analgesia, physical rehabilitation

Question 5

MSK injuries of the hip

-common injuries in active adults

Answer 5

Tendon strain, stress fractures

Osteitis pubis - repetitive trauma across symphysis

Question 6

Trochanteric bursitis

• pathophysiology
• common in
• management

Answer 6

Trochanteric bursitis - caused by inflammation/physical trauma in muscles, tendons, bursa
-female 40-60 with OA, RA, fibromyalgia

Conservative - rest, analgesia, physio, CS injection

Question 7

Femoroacetabular inpingement

• pathophysiology
• presentation

Answer 7

Cam - flat femoral head/neck junction
Pincer - overcoverage of head by acetabulum
Rubbing of articular cartilage against labrum => damage

Hip/groin pain linked to certain mv
Pain may radiate to thigh, back

Question 8

GENERAL ASSESSMENT FOR LIMBS

Answer 8

Mechanism of injury
Xray joint, above and below
Assess neurovasculature
Analgesia
Fluids especially in femoral fractures
WATCH OUT FOR COMPARTMENT SYNDROME
Refer to ortho if in doubt