NoF

Question 1

Prog

Answer 1

25-30% mort at one yr

Pre inj motility BIG indicator, and chronic renal fail

Question 2

Imp anatomy

Answer 2

Normal neck shaft angle 130
Normal anteversion 10
BS- medial circumflex, some lat circumflex and infer gluteal. At risk if displ intracaps frac.

Question 3

Garden classification

Based on AP only

Answer 3

1- incompl ie valgus impacted
2- compl frac, non displ
3- compl, partial displ
4- compl, full displ

Question 4

Px

Answer 4

If displ- ext rot, abduc, short.

WHY-

Question 5

Mx

Answer 5

-obs only and PK, splint
Non mobile, minim pain, high risk surg, undispl
-ORIF for displ fracs in under 65s
-cannulated screw if non displ eld, or yng.
-DHS
-hemi in low mobil eld, metab bone dis
-THR in eld active, pre exist OA, v displ.

Question 6

Complics

Answer 6

AVN 10-45%
Non union 5-30%
Disloc, higher risk if had THR (10%)
OA
Failure after 10 yr- 46% for fixat, 8% arthroplasty.
THR/surg- DVT, PE, pneum, bed sores, exacerbation prev illness.

Question 7

RFs

Answer 7

Caucasian
Female
Over 70
OP, OM
DM
CVS
Alc
Chronic disbilitating dis
Musc weakness
Poor bal

Question 8

Intracapsular poor heal due to

Answer 8

Dam retinacular vess
Lack periosteum and soft tiss contact so inadeq callus
Synovial fluid in caps prevs clotting of haematoma

Question 9

mx summ

Answer 9

Undispl intracaps- cannulated screw
Displ intracaps- hemi, or THR if ambulant and fit. Or fix if v yng and fit ad not too displ.
Basicarvical or intertroch- DHS
Trans/sub troch- IMHS, somet DHS

Question 10

Gen mx in eld

Answer 10

Morphine and femoral N block
XR, or CT/MRI
Pre surg check- FBC, clotting, UE, CXR, ECG, crossmatch 2U, consent.
Sort other med issues pre op.

Question 11

hip norm ROM

Answer 11

Flex 110-135
Abduc 30-40
Adduc 20-30
Int rot 30-40
Ext rot 40-50

Question 12

leg length

Answer 12

Ture- ASIS to medial mall

Question 13

trendelenburg pos causes

Answer 13

Abduc paral eg glut medius and min. Eg N root lesion, pain, post op N dam, OA weakened muscs.
Upw displ of greater troch eg sev coxa vara or disloc hip.
Absent stable fulcrum eg un united frac NoF.

Question 14

hip OA

Answer 14

RFs- age, trauma, post op, post infec, malposit, mech instabil, osteochondritis dissecans, AVN, pead hip dis.
Hx- poor loc pain, can ref to knee. Worse on weight bear. Stiff eg when flex.
OE- antaligic trendel pos. reduc ROM esp int rot.