NOF Fractures, OA Of Hip And Knee Flashcards
What is the 1 year mortality rate for neck of femur fractures?
30%
What type of injury commonly cause neck of femur fractures?
Low energy fragility fractures
High energy trauma
What are the 2 categories of neck of femur fractures?
Intracapsular
Extracapsular
What is classified as an intracapsular neck of femur fracture?
Any fracture from the intertrochanteric line proximally
What is the name of the classification system for neck of femur fractures?
Garden classification
What is the Garden classification?
I = non displaced incomplete fracture
II = non displaced complete fracture
III = partially displaced complete fracture
IV = fully displaced complete fracture
What is a I on the Garden classification for NOF fractures?
Non displaced incomplete fracture
What is a II on the Garden classification for NOF fractures?
Non displaced complete fracture
What is a III on the Garden classification for NOF fractures?
Partially displaced complete fracture
What is a IV on the Garden classification for NOF fractures?
Fully displaced complete fracture
When a patient presents with suspected NOF fracture what questions do you want to know?
Falls history
Blood thinners? Antihypertensives? Long term corticosteroids (weaken bone)
Social support at home
What is the acute initial managemtn of a patient with a NOF fracture?
A-E assessment
Resuscitate
What is the acute initial managemtn of a patient with a NOF fracture?
A-E assessment
Resuscitate
What is the acute initial managemtn of a patient with a NOF fracture?
A-E assessment
Resuscitate
How does a patient with a NOF fracture typically present?
Trauma
Unable to weight bare
Thigh, groin or referred knee pain
Leg in alternate position at res
On examination of the hip how does the lower limb typically present?
Why?
Shortened
Externally rotated
Psoas pulls up shortening
Gluteus max and deep gluteals externally rotate
What is important to assess with ha NOF fracture on examination?
Neurovascular status
Test sensation and pulses distally
What Ix should you do if you suspect a NOF fracture?
FBC
U+Es
G+S and cross match
Obs
Blood glucose
ECG
Urine dip
Creatine kinase (rhabdo?)
VBG
What is the gold standard imaging for a NOF fracture?
Plain radiograph AP + lateral of the pelvis
Sometimes full length femur too if think pathological fracture
Can do CXR for full patient work up if they are older patient
Why are intracapsular neck of femur fractures worse than extracapsular?
Retrograde blood supply to the femoral head via the medial femoral circumflex artery
If intracapsular fracture and is displaced can disrupt this blood supply leading to Avascular necrosis of the femoral head
What is the name of the line that can be used to help identify NOF fractures on X-ray?
Shentons line
What is shentons line?
Runs from medial edge of femoral neck along the inferior border of the superior pubic ramus
Look on page 2 of notes.
What is the initial management for a patient with a NOF fracture?
Analgesia (opioids or regional anaesthesia)
Cease DOAC
Keep NBM (prep for surgery)
IV fluids
What is an example of a regional anaesthetic technique used for analgesia with a NOF fracture?
Fascia iliaca block
What is a fascia iliaca block?
Local injected under tensor fascia lata to try and block the femoral nerve
What are the 2 consent forms used for adults?
Forms 1 and forms 4
Who is consent form 1 used for?
Adults with capacity
Who is consent form 4 used for?
Adults without capacity (need 2 doctors signatures)
What is the method of management for a patient with a NOF fracture?
Surgical
What is the goal of operating on someone with a NOF fracture?
Mobility
Pain relief
Pre event status
Ideally weight bearing straight after operation
What is the surgical management for a patient with a non displaced (Garden class I or II) NOF fracture?
Fix it in place
DHS (Dynamic Hip Screw)
Cannulated Hip Screws
What is the surgical management for patients that have displaced intracapsular NOF fractures (Gardens III or IV)?
Replace the joint
Hemiarthorplasy
Total Hip Replacement
When do you do a hemiarthroplasty or a Total Hip replacement for a patient with a Gardens III or IV intracapsular NOF fracture?
If is gonna get good use out of it do a Total Hip (they walk independently alone outside with no more than 1 stick)
What is the surgical management of an extracapuslar NOF fracture?
Internal fixation:
DHS or IM nail
What are the short term complications of repair of NOF fractures?
DEATH
Bleeding
Pain
Infection
DVT/PE
Stiffness
Limb length discrepancy
Nerve/vessel/bone damage
Dislocation
What are the long term complications of a hemiarthroplasty or total hip replacement?
Dislocations
Peri-prosthetic fracture
Prosthetic joint infection
Aseptic loosening
Mal union/non union
What is the post op management for a patient who just had a hemi-arthroplasty or THR?
Mobilise + rehab
Assessed by orthogeriatricians
Prevent future falls + fragility fractures
What is the screening tool we used to assess a patients 10yr probability of having a fracture?
WHO FRAX Score
Why is the WHO FRAX score important in post op NOF fracture management?
Determines who we should be giving bone protecting medicine
Who do we use the WHO FRAX score on and who do we give immediate bone protection to?
Age < 75s use WHO FRAX tool
Age > 75 start BONE PROTECTIOON
What medication class do we use for bone protection?
Bisphosphonates
Replace vitamin D/calcium
What bisphosphonates are used as bone protection?
Alendronic acid orally
Or
IV Zolendronic acid