MSK NOF# Teaching Flashcards
what are risk factors for NOF#
f>65 m>75
PMHx of osteoporosis
previous fragility fractures
Hx of falls
poor nutrition
low BMI
dementia
visual impairment
Hx of malignancy
which drugs should you ask about when taking a history for NOF#
medications that contribute to osteoporosis (steriods)
meds that increase falls (sedatives, BBlockers, antihypertensives)
anticoagulants - increase risk of bleeding, have to be stopped before surgery
what are important aspects for social history with NOF#
lifestyle
home situation
living enviroment
activities of daily living
care support requires
what do you expect to find on examination for a NOF#
leg is shortened, externally rotated and abducted
pain on palpation
unable to perform straight leg raise
log roll test - pain on gentle internal and external rotation
bruising and swelling around the hip
what are some investigations you could consider for suspected NOF#
bedside: ECG for arrhythmias
Lab: baseline blood tests, creatinine kinase, urinalysis, group and save
Imagining: XR, if uncertain MRI/CT can be used to exclude #
what are the lines you assess for hip XR
shentons line
what is the classification system for NOF#
garden classification
1- incomplete #, minimal displacement
2 - complete #, non-displaced
3- complete #, partially displaced
4- complete #, completely displaced
3 and 4 are high risk
what are some steps which can be done for initial management of NOF#
analgesia - not NSAIDs.
opiods, nerve blocks, paracetamol
obtain venous access
prepare for surgery - if needed
manage: anaemia, hypovolaemia, anticoagulation and infection
what should be done with elderly patient with NOF#
need to be seen by an orthogeriatrician within 72 hours
when can ORIF be used for intracapsular fractures
in patients <65yrs
those who are physiologically fit
what is the main surgical option for intracapsular #
hemiarthroplasty: tends to be preferred in less mobile older patients, as there is some loss of mobility
total hip replacement: preferred in active patients
what surgical option are there for extracapsular nof# or subtrochanteric #
internal fixation with dynamic hip screws or intramedullary nails
as blood supply to femur head is generally preserved
what is the main blood supply to the head of the femur
medial circumflex artery from the deep femoral artery
what are the aims of post operative care for NOF#
early mobilisation
prevent further falls
VTE prophylaxis
ABX
orthogeriatrician - falls assessment, assess need for bone protection
which scoring tool can be used for fracture risk
FRAX
WHO fracture risk assessment tool
