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#passmed 2022 > Neck of Femur Fracture > Flashcards

Neck of Femur Fracture Flashcards

1
Q

What are the risk factors of NOF #?

A

Age bc osteoporosis + increased risk of falls

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2
Q

Why do the elderly have increased risk of falls? (4 things)

A
  1. Neurovasc lesions
  2. Medications
  3. Dehydration
  4. Cognitive impairment
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3
Q

How are NOF # classified? (2 things)

A
  1. Intra-capsular
  2. Extra-capsular
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4
Q

Where is the # in intra-capsular NOF #? (3 parts)

A

In these parts of the NOF:

  1. Subcapital
  2. Transcervical
  3. Basocervical
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5
Q

What are the 2 types of extra-capsular NOF #?

A
  1. Inter-trochanteric (greater –> lesser trochanter)
  2. Sub-trochanteric (from lesser trochanter and down 5cm)
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6
Q

What classificiation system is used to classify Intra-capsular NOF #s?

A

Garden Classification

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7
Q

What is the Garden Classification System for Intra-capsular NOF #s? (4 things)

A
  1. Non-displaced, incomplete #
  2. Non-displaced, complete #
  3. Partially displaced, complete #
  4. Fully displaced, complete #
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8
Q

How do intra-capsular #s disrupt blood supply to femoral head? (2 points)

A
  1. Blood supply to NOF is retrograde (passes distally -> proximally from neck to head)
  2. Blood supply is thru medial circumflex femoral artery (lies on intra-capsular femoral neck)
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9
Q

What can an intra-capsular NOF # lead to?

What will this therefore require?

A

AVN

Requires arthroplasty (replacement) NOT fixation

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10
Q

What are the clinical features of NOF #s? (3 things)

A
  1. Pain
  2. Inability to weight bear
  3. Leg shortened + ext. rot. @ examination
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11
Q

Where is the pain in NOF #s? (3 things)

A
  1. Groin
  2. Thigh
  3. Referred to knee (elderly)
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12
Q

What scans should be done for suspected NOF #? (2 things)

A
  1. AP + Lat XR of affected hip
  2. AP Pelvic XR
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13
Q

Why is an AP Pelvic XR done in suspected NOF #?

A

To assess normal hip for pre-op planning + templating

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14
Q

What tests should be done for suspected NOF #? (7 things)

A
  1. FBC
  2. U&Es
  3. Coag screen
  4. G&S

For elderly

  1. Urine dip
  2. CXR
  3. ECG
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15
Q

What is the initial management for NOF #? (3 things)

A
  1. Morphine (pain relief)
  2. IV fluids (rehydration / maintain hydration whilst starved)
  3. Thromboprophylaxis
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16
Q

What are the management options for Intra-capsular UNDISPLACED NOF #? (2 things)

A
  1. Conservative
  2. Internal fixation
17
Q

What are the management options for Intra-capsular DISPLACED NOF #? (2 things)

A
  1. Internal fixation
  2. Arthroplasty
18
Q

What are the management options for Extra-capsular NOF #? (3 things)

A
  1. Traction
  2. Intramedullary fixation
  3. Extramedullary fixation
19
Q

What are the indications for Conservative management of NOF #?

A

IMPACTION type intra-capsular undisplaced #
(RARELY DONE)

(impaction = 2 pieces of fractured bone driven into each other)

20
Q

What are the indications for Internal fixation of NOF #? (2 things)

A
  1. Intra-capsular undisplaced
  2. Intra-capsular MINIMALLY displaced
21
Q

What is Internal fixation of NOF #?

A

3 cannulated screws to stabilize broken bones

22
Q

What are the 2 types of Arthroplasty of NOF #?

A
  1. Hemiarthroplasty (HA)
  2. Total Hip Replacement (THR)
23
Q

What is the difference between Hemiarthroplasty and Total Hip Replacement?

A 
HA = Only femoral head replaced w prosthesis 
THR = both femoral head + acetabulum replaced
24
Q

What are the indications for Arthroplasty of NOF #? (2 x THR vs 2 x HA)

A

THR

  1. # in RA
  2. # 2ndary to Malignancy

HA

  1. # in elderly
  2. # 2ndary to Paget’s Disease / Met Bone Disease / OA

(All displaced intra-capsular obv)

25
Q

What are the management options for Extra-capsular NOF #? (3 things)

A
  1. Traction
  2. Intramedullary fixation
  3. Extramedullary fixation
26
Q

What is the indication of Traction of a NOF #?

A

Extra-capsular #

27
Q

What is Traction of a NOF #?

A

Use tapes / pins attached to weights to pull + decompress hip joint

28
Q

What is the benefits of Traction of a NOF #? (3 things)

A
  1. Relieves pain
  2. Relaxes muscles
  3. Restores mobility
29
Q

What is the indication of Intramedullary fixation of a NOF #?

A

Extra-capsular #

30
Q

What is Intramedullary fixation of a NOF #?

A

Titanium rod placed thru medullary cavity of femur for stabilisation

31
Q

What is the indication of Extramedullary fixation of a NOF #?

A

Extra-capsular #

32
Q

What is Extramedullary fixation of a NOF #?

A

Dynamic Hip Screw (DHS)

3 parts:

  1. Lag screw into neck
  2. Sideplate
  3. Bicortical screws

Lag screw slides thru slide plate

33
Q

What does DHS Extramedullary fixation of a NOF # allow? (3 things)

A
  1. # compression
  2. Primary Healing
  3. Maintains neck shaft angle of femur
34
Q

What are the complications of NOF #? (2 things)

A
  1. AVN
  2. Non-union (inability to heal #) (most common complication)
35
Q

How long does the risk of AVN exist after surgery of NOF #?

36
Q

What is needed to monitor for AVN in NOF #? (2 points)

A
  1. Regular scanning
  2. MRI better than X-Ray for AVN detection
37
Q

What type of NOF # is non-union more common in?

#passmed 2022 (27 decks)

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