NOF#

Question 1

74 y.o. woman admited to A+E having been found on the floor at home. unable to get up and complains of pain and weakness in the right leg. you suspect a fractured neck of femur.

(a) what 2 features would you look for on inspection of the legs to confirm your dx?

Answer 1

R leg will be shortened in comparison to the L leg

R leg will be externally rotated in comparison to the L leg

Question 2

(b) the X ray demonstrates an intra-capsular fracture of the right hip. what is the anatomical significance of a fracture at this site?

Answer 2

• blood supply to the femoral head in a distal-proximal fashion
• site of intra-capsular fracture means that blood supply to femoral head is potentially compromised and there is a risk of AVN of the femoral head

Question 3

(c) you are concerned about the dx of osteoporosis in a lady with a previous fracture. you proceed to undertake a DEXA scan. which areas are routinely screened for the presence of osteoporosis?

Answer 3

• neck of femur
• lumbar vertebrae

Question 4

(d) briefly (<30 words) describe how DEXA scan works

Answer 4

• two distinct XR beams passed through the pt
• one beam is absorbed by soft tissue, the other by bone
• BMD = total XR absorbed – XR absorbed by soft tissue

Question 5

(e) give 2 drug therapies which may be of benefit in osteoporosis

Answer 5

• bisphosphonates
• calcitriol

Question 6

(f) given the above information, what operation would be most appropriate?

Answer 6

hemiarthroplasty

Question 7

(g) she makes a good recovery from the operation. name 2 factors related to her social situation that you would wish to take into account when planning her discharge.

Answer 7

• she lives alone – who will look after her?
• what is her home like – hazards, stairs, where is the bathroom, shower?