#NOF Flashcards
Types of NOF Fractures
- Intracapsular
- Extracapsular Trochanteric
- Extracapsular Subtrochantic
Causes of NOFs
- High or low energy mechanism
- Pathological fracture
- Stress fracture - less common
Garden Classifications of NOF
Stage I - incomplete fracture line
Stage II - complete fracture line with no displacement
Stage III - complete fracture line with partial displacement
Stage IV - complete fracture line with complete displacement
Blood Supply in NOFs
NOF can lead to impaired blood supply, lack of oxygen delivery and therefore necrosis of the bone tissue, and associated joint tissue
Signs and Symptoms of NOFs
- Hip/groin/thigh/foot pain (dementia struggle to localise pain)
- Shortening and rotation (may not see if lower grad fracture, can also get short+rot in midshaft)
- Inability to weight bear and straight leg raise
Potential Primary Survey of NOF
If pt has been on the floor for a significant amount of time then may see signs of:
- Signs of significant dehydration eg hypotension
- Hypothermia
- Pressure sores
NOF Assessment
Inspect - any bruising/swelling, obvious deformity, look for shortening and rotation of the foot
Palpation - any deformity, pain? Feel for pedal pulse
Movement - can they move their toes, bend their knee. can they straight leg raise?
Secondary Survery for NOF; MOI, PMH, SH
Mechanism (can be low impact)
PMH - long term steroid use, anaemia, osteoporosis, cancers
SH - normal levels of activity, alcohol use (increase fat lvl in blood which decreases recovery ability, smoking decreases bone density)
Risk Factors for NOFs
- Caucasian
- Female
- Age
- Oestrogen levels
- Smoking
- Alcohol abuse
- Lower bone density
- Frq falls
- Young, female runners
- Low activity levels
Medication that Increase Likelihood of #NOF
Sedative Medication - increase fall risk
PPIs eg omeprazole - decrease absorption of B12
Multiple drug combos
Alcohol
Fall Hx in NOFs
- Gather fall history as normal
- How long have they been on the floor?
- Look out for signs of rhabdomyolysis (usually significant in long lie of over 4hrs)
- Have they been able to move around/drink/eat while on the floor?
- Try to ascertain cause of fall - do ECG ect
Immobilisation for NOFs
- Don’t pull if NOF (discuss CCD if mid shaft also suspected)
- Scoop, vac mat + stretcher is gold standard
- Can put blanket between with bandage but only makes comfy, little to no research
Analgesia in NOFs
Remember to do a pain score and use abbey pain scale for cognitive impairment pts
IV - morphine, paracetemol
Oral - paracetemol, ibroprufen
IM - morphine
Inhaled - entonox, penthrox
Extrication for NOFs
Gold standard is scoop and vac mat
NICE guidelines recommend surgery the day of or the day after the incident
Surgery in NOFs
The type of surgery will depend on the classification of break as well as if the fracture is displaced or not
Surgeries range from screws up to total hip replacement
