Lower Limb

Question 1

What are the three types of hip fracture?

Answer 1

1. Femoral neck (subcapital) - intracapsular
2. Intertrochanteric - extracapsular fracture including the greater and lesser trochanters and transitional bone between the neck and shaft
3. Subtrochanteric - fracture begins or below the lesser trochanter and involves the proximal femoral shaft

Question 2

Describe the Garden classification of femoral neck fractures,

Answer 2

Type I - undisplaced incomplete/valgus impacted
Type II - undisplaced complete (across the whole neck)
Type III - complete fracture, incompletely displaced
Type IV - complete fracture, totally displaced

Question 3

How is an extracapsular femoral fracture fixed?

Answer 3

Intertrochanteric: DHS Subtrochanteric: intramedullary nail

Question 4

What is Shenton’s line and what is its significance?

Answer 4

Formed by the medial edge of the femoral neck and the inferior edge of the superior pubic ramus

Loss of contour of Shenton’s line is a sign of a NOF #

But fractures of the femoral neck do not always cause loss of Shenton’s line

Question 5

What thromboprophylaxis is used post-surgery?

Answer 5

enoxaparin + TEDS

SC 40mg

Question 6

How is a Type I NOF fixed?

Answer 6

Internal fixation to prevent displacement

Question 7

How is a Type II NOF fixed?

Answer 7

Internal fixation to prevent displacement

Question 8

How is a Type III NOF fixed?

Answer 8

Elderly: hemi-/total hip arthroplasty
Young: ORIF

Question 9

How is a Type IV NOF fixed?

Answer 9

Elderly: hemi-/total hip arthroplasty
Young: ORIF

Question 10

Describe the blood supply of the femoral head.

Answer 10

Distal to proximal blood supply along femoral neck to head (medial and lateral femoral circumflex arteries)

Susceptible to AVN if blood supply disrupted

Question 11

Which movements are lost first in hip arthritis?

Answer 11

Internal rotation and abduction

Question 12

What bloods would you order in a patient with a hip fracture?

Answer 12

FBE - Hb, platelets
Coagulation profile
UEC
CMP
LFT
Blood cultures/MSU - if clinically indicated
Group and hold

Question 13

How is hip OA managed?

Answer 13

Non-operative:

1. Analgesia
2. Weight loss if appropriate
3. Activity modification (avoid activities that aggravate hip pain)
4. Walking aid
5. Physiotherapy: to condition muscles
6. Inflammatory process: joint steroid injections

Operative:

1. Most common - THR
2. Re-alignment osteotomy
3. Arthrodesis

Question 14

What are the complications of a THR?

Answer 14

General risks: bleeding, infection, anaesthetics

Specific: Nerve injury (sciatic, femoral, obturator), leg length discrepancy, need for revision surgery, dislocation and fracture