Neck of femur fracture

Question 1

What is the mortality of a neck of femur fracture at 1 year and why

Answer 1

30% due to the frailty of the patient population

Question 2

What causes a neck of femur fracture?

Answer 2

Low energy injuries such as fall in frail older patients or high energy falls such as road traffic collisions

Question 3

What does the femoral head sit within?

Answer 3

acetabulum

Question 4

What is the femoral heads blood supply?

Answer 4

Uni-directonal mainly from the medial femoral circumflex artery which lies in the femoral neck

Question 5

What blood supply to the femoral head is important in children?

Answer 5

Ligamentum arteriosum

Question 6

What is an intracapsular neck of femur fracture?

Answer 6

Either sub capital (through the junction of the head and neck) or basocervical (through the base of the femoral neck)

Question 7

What is an extracapsular neck of femur fracture?

Answer 7

intertrochanteric (between the two trochanters) or subtrochanteric( <5cm distal to the lesser trochanter)

Question 8

What does the garden classification system look at for intracapsular fractures?

Answer 8

If displaced or not

Question 9

What are the clinical features of a neck of femur fracture?

Answer 9

history of a recent fall, significant pain and unable to weight bear

Question 10

On examination how would a neck of femur fracture look?

Answer 10

Shortened and externally rotates due to the pill of the short external rotators, with pain on pin rolling and axial loading, unable to straight leg raise

Question 11

What are the differential diagnosis for neck of femur fractures?

Answer 11

fractured pelvis or other fractures

Question 12

What investigations would be done for a neck of femur fracture?

Answer 12

radiographs- AP and lateral, of the affected hip and of the pelvis to help with planning and templating pre op, routine blood tests, urine dip and CXR, ECG to complete assessment in older patients

Question 13

What is the management for a neck of femur fracture?

Answer 13

A to E approach to stabilise patient, analgesia and then surgery

Question 14

How would a sub capital neck of femur fracture be treated?

Answer 14

Hip hemiarthroplasty or total hip replacement

Question 15

How would a Intertrochanteric and basocervical neck of femur fracture be treated?

Answer 15

Dynamic hip screw

Question 16

How would a non displaced intra-capsular neck of femur fracture be treated?

Answer 16

Cannulated hip screws

Question 17

How would a subtrochanteric neck of femur fracture be treated?

Answer 17

Intramedullary femoral nail

Question 18

Who would a Hemiarthroplasty be suitable for?

Answer 18

Patients who are old, small, less able, and would not likely wear through the bone

Question 19

What are some post operative complications of surgery to fix a neck of femur fracture?

Answer 19

Pain, bleeding, leg length discrepancies, neurovascular damage

Question 20

Who should neck of femur fractures be looked after after treatment?

Answer 20

orthodontist-geriatricians, early rehab, physiotherapy and occupational therapists

Question 21

What are some long term complications of neck of femur fractures?

Answer 21

joint dislocation, aseptic loosening, peri-prosthetic fracture