Neck Of Femur Fracture Flashcards
Mr. Jones is an 80-year-old male who presents to the emergency department with severe pain in his right hip and difficulty walking. He reports that he was walking in his garden when he tripped and fell, landing on his right hip. He immediately felt a sharp pain and was unable to get up without assistance. He denies any loss of consciousness or other injuries.
Please have a look at this X-ray and state the diagnosis.
Left neck of femur fracture
The doctor suspects a left neck of femur fracture. Please describe and explain why Mr Jones’s leg is in this particular position.
The left leg is shortened, abducted and externally rotated at the hip.
This happens because the axis of rotation of the femur that normally passess obliquely through the head and down the neck of the femur, shifts to pass through the greater trochanter and vertically down the long axis of the femoral shaft.
Externally rotate: The piriformis, obturator internus, superior and inferior gemelli and quadratus femoris externally rotate the femoral shaft.
Abduct: The gluteus medius and minumus abduct the femur distal to the fracture site.
Shorten: The rectus femoris and adductor magnus pull the distal fragment of the femur upwards.
Why are intracapsular fractures more troublesome?
They are likely to disrupt the ascending cervical branches of the MFCA. Due to the inability of the artery of ligamentum teres to sustain the metabolic demand of the femoral head, there is high risk of avascular necrosis of the bone.
Mr Jones undergoes a total left hip replacement. However later he experiences a fever and pain and swelling around his left hip joint. The doctor suspects the patient may have septic arthrits. What is septic arthritis?
The invasion of the joint space by micro-organisms.
Please have a look at this gram stain and state the most likely pathogen to have caused the septic arthritis.
Staphylococcus aureus
