NOF Flashcards
What are the two mechanisms of injury in NOF?
Low energy
High energy
Where do NOF happen?
Anywhere from supcapital region of the femoral head to 5cm distal to lesser trochanter
What are the two main classifications of NOF?
Intracapsular
Extracapsular
What are the two types of extra-capsular fractures?
Inter-trohanteric
Sub-trochanteric
What is important to ask about in the history of NOF?
- Preceding event - identify cardio/neurological causes
- Mechanism of fall
- level of function prior to fracture
What is an obvious finding of examination of NOF?
Shortened and externally rotated leg
What is the main blood supply that may be disrupted in a displaced intracapsular NOF?
Medial circumflex artery - avascular necrosis
Requires arthropalsty
What is the classification system used of NOF?
Garden classification
What is the garden classification?
I - incomplete and undisplaced
II - complete fracture but undisplaced
III - complete and partial displacement
IV - complete and fully displaced
What examinations would you perform on someone presenting with suspected NOF?
Signs of neurovascular compromise Tenderness Movement Other injuries Head injuries
What investigations would you do for suspected NOF?
Bedside: BP, ECG, urine dip, A to E, blood glucose
Bloods: FBC, U&Es, group and save, coagulation, bone profile/vit D, CK levels
Imaging: X-ray (AP+Lateral), CXR, whole femur X-ray for pathological fractures, CT and MRI(gold standard) if fracture can’t be seen on x-ray.
What are signs of rhabdomyolysis?
Renal failure and coke coloured urine
What type of analgesia can be given in NOF?
Opioid
Regional block - fascia-iliaca block
What are the side effects of opioids?
Delirium
Constipation - prescribe laxatives as well
When is fascia-iliac block contraindicated?
Hypercoagulable states
Pt on anti-coagulants
What other medication/things can be prescribed other the analgesia for NOF?
LMWH - DVT prophylaxis
Fluids - blood loss of up to 500ml in NOF
Prophylactic antibiotic’s
What are the surgical options for NOF?
- Displaced sub capital - Hip arthroplasty (total/hemi)
- Inter-trochanteric and basocervical - dynamic hip screw/ short IM nail
- non-displaced intra-capsular - cannulated hip screws
- sun-trochanteric - anterograde intramedullary femoral nail
What is the Nottingham hip fracture score?
Predicts 30 day mortality after hip fracture surgery
7 independent factors
NHFS>=6 cut-point for high mortality
Why is serum lactate relevant in NOF?
Increase in venous lactate is predictor of early death
What are the complications of surgery in NOF?
Pre-op - delirium, reduced mobility, bleeding, death
Intra-op - bleeding, nerve damage, muscle damage
Post -op - delirium, pressure sores, reduced mobility, PONV, bleeding, osteonecroisis, dislocation, DVT/PE, wound infection, chest infection - pneumonia, leg length discrepancies, neurovascular damage
What should be done post-op to achieve best outcome for pts with NOF?
Early rehab - physio and OT
What should pts with fragility fracture be on?
Bisphosphonates
Which types of fractures are commonly associated with fragility fractures?
NOF
Spine
Wrist
What is consent form 1 and 4?
Consent 1 - all adult pts consenting to treatment and have capacity
Consent 4 - Adult pts without capacity, best interest intervention done and next of kin informed. Signed by 2 consultants.
