Neck of femur fractures

Question 1

Can you list 4 risk factors for NOF fracture?

Answer 1

1. Fall
2. Osteoporosis
3. Reduced activity
4. Chronic medication use

Question 2

List 6 non-modifiable risk factors for NOF fractures

Answer 2

1. Age >65
2. Sex - female
3. Family history
4. Prior hip fracture
5. Low socioeconomic status

Question 3

List 5 modifiable risk factors for NOF fractures

Answer 3

1. Medications - Thyroxine, frusemide, PPI and sedatives
2. Falls
3. OP
4. Vitamin D deficiency
5. Reduced level of activity

Question 4

List the two broad categories of NOF fractures

Answer 4

Intracapsular and extracapsular fractures

Question 5

List types of intracapsular fractures (4)

Answer 5

1. Femoral head
2. Femoral neck
   - Subcapital
   - Transcervical
   - Basicervical

Question 6

List types of extracapsular fractures (2)

Answer 6

1. Intertrochanteric
2. Subtrochanteric

Question 7

Clinical presentation of NOF fracture

Answer 7

Inability to weight bear + pain in the hip
Consider the cause of the fall in case of acute medical cause such as heart attack or stroke.
Consider other injuries
Pain can be referred to distal femur or upper knee
Non-displaced NOF fractures can appear normal at first.

Displaced NOF fracture
- Leg is shorted, in ER
Muscle spasm will contribute to shortening the limb

Posterior dislocated femur
- Shortened, adducted and internally rotated

Question 8

How is a NOF fracture diagnosed?

Answer 8

Clinical presentation
X-ray
Blood test performed to screen for vitamin D and calcium

Question 9

Prior to surgery analgesia

Answer 9

Femoral nerve block
Short acting opioids

Question 10

Correct surgical technique for undisplaced intracapsular fracture?

Answer 10

Cannulated screws
DHS

Question 11

Correct surgical fixation for displaced intracapsular fracture

Answer 11

Hemiarthroplasty
Or - THR if previous independent outdoor mob and likely to be independent for 2+ years or pre-existing symptomatic arthritis

Question 12

Correct surgical fixation for intertrochanteric fracture?

Answer 12

Sliding screw or DHS

Question 13

Correct surgical fixation for subtrochanteric fracture?

Answer 13

IM Nail

Question 14

List complications of NOF fractures

Answer 14

Death (normally due to high occurrence in elderly)
non-union
AVN
Dislocation of arthroplasty
Mal-union
Loss of fixation
Lower limb thromboembolic disease