neck of femur fractures

Question 1

what causes NOF#?

Answer 1

• low energy injuries eg. a fall

- high energy injuries e.g road traffic collision, affecting ipsilateral side

Question 2

what is the blood supply to the femoral head?

Answer 2

medial and lateral circumflex arteries arising from the profunda femoris

Question 3

why is the medial femoral circumflex artery vulnerable to damage in a #?

Answer 3

because it lies directly on the femoral neck

Question 4

how are NOF# classified?

Answer 4

by fracture line in relation to joint capsule

• intracapsular = either subcapital (through junction of head and neck) or basocervical (through base of femoral neck)
• extracapsular = intertrochanteric (between two trochanters) or subtrochanteric

Question 5

how can intracapsular fractures be further classified?

Answer 5

by the garden classification

asses level of displacement

Question 6

what are the clinical features of NOF#?

Answer 6

• history of recent fall or trauma
• inability to weight bear
• significant pain in groin
• may be history of osteoporosis or renal failure
• leg is shortened and externally rotated
• inability to straight leg raise
• usually NV intact

Question 7

what are your differentials?

Answer 7

• pelvic fractures

- pathological fractures should be considered if no history of trauma

Question 8

what investigations are done for a NOF#?

Answer 8

• AP and lateral plain radiographs of the affected hip
• AP view of pelvis to asses contralateral hip also
• routine bloods and coagulation screen and group and save
• creatinine kinase level to asses rhabdomyolosis
• urine dip, CXR and ECG for complete assessment for pre operative patient

Question 9

what is the management of a NOF#?

Answer 9

A to E approach

adequate analgesia

definitive management is surgical

Question 10

what is the treatment for a subcapital NOF#?

Answer 10

hip hemiarthroplastry

replacement of the femoral head and neck via femoral component fixed in the proximal femur

Question 11

what is the treatment for an intertrochanteric and basocervical NOF#?

Answer 11

dynamic hip screw

consists of lag screws into the neck, a sideplate and cortical screws

Question 12

what is the treatment for a no displaced intracapsular NOF#?

Answer 12

cannulated hip screws

three non parallel hip screws in inverted triangle formation

Question 13

what is the treatment for a subtrochanteric NOF#?

Answer 13

intramedullary femoral nail

metal rod is placed through medullary cavity of the femur for stabilisation

Question 14

what are the complications of a NOF#?

Answer 14

post operatively

• pain
• bleeding
• leg length discrepancies
• potential NV damage
• manage under ortho-geriatricians
• physio is needed

longer term complications

• joint dislocation
• aseptic loosening
• peri prosthetic fracture
• mortality following is 30% at one year