Images Viva Qs/Facts

Question 1

Pathophysiology of hip fractures:

old vs young

Answer 1

Old= osteoporosis with minor trauma (e.g. fall)

Young = major trauma

Question 2

Osteoporosis RF

(Age + SHATTERED)

Answer 2

Age

Steroids

Hyper=para/thyroidism

Alcohol and cigarettes

Thin (BMI <22)

Testosterone low

Early menopause

Renal/liver failure

Erosive/inflame bone disease .e.g. RA, myeloma

Dietary Ca low/malabs, DM

Question 3

Presentation and key Qs for NOF#

(o/e and Qs)

Answer 3

Presentation

o/e: shortened externally rotated

Key Qs:

• Mechanism
• RF for osteoporosis/path #
• Premorbid mobility
• Premorbid independence
• comorbidities
• MMSE

Question 4

Initial Management of NOF#

Answer 4

• Resuscitate: dehydration, hypothermia
• Analgesia: M+M
• Assess NV statur of lumb
• Imaging: AP and lateral film
• Prep for theatre:
  
  • inform anaesthetist and book theatre
  • bloods: FBC, U&E, clotting, x-match (2u)
  • CxR
  • DVT prophylaxis: TEDS, LMWH
  • ECG
  • Films: orthogonal x-rays
  • Get consent

Question 5

What to look for on imaging of a NOF#

Answer 5

• Ask for AP and lat films
• look at Shenton’s lines
• Intra or extracapsular
• displaces or non-displaced
• osteopenic

Question 6

Key anatomy for NOF#

Answer 6

• capsule attaches proximally to acetabular margin and distally to intertrochanteric line
• blood supply to fem head:
  
  • retinacular vessels in capsule (distal to proximal)
  • Intramedullar vessels
  • artery of ligamentum teres

if retinacular vessels damaged there is a risk of AVN of fem head -> pain, stiffness and OA

Question 7

Classification of NOF#

Answer 7

Intracapsuar: subcapital, transcerical, basicervical

Extracapsular: intertrochanteric, subtrochanteric

Garden classification of intracapsular:

1. incomplete #, undisplaced
2. complete #, undisplaced
3. Complete #, partically displaced
4. Complete #, completely displaced

Question 8

specific complications of NOF# management

Answer 8

AVN of fem head in displaced # (30%)

Non/malunion (10-30%)

infection

OA

Question 9

Management of NOF#

Answer 9