Principles of Fracture Management - Hip Fractures

Question 1

What is the Hip Joint Capsule?

Answer 1

A Strong Fibrous Structure attaching rim of Acetabulum of Pelvis to Intertrochanteric Line on Femur (surrounding head and neck).

Question 2

Arterial Supply of Hip Joint Capsule.

Answer 2

Retrograde Blood Supply :

1. Medial & Lateral Circumflex Femoral Arteries join Femoral Neck just proximal to Intertochanteric Line.
2. Their branches run along neck surface (within capsule) to the head.

Question 3

Which type of Hip Fractures are associated with Avascular Necrosis?

Answer 3

Intracapsular NOF fracture - damages branches of medial and lateral circumflex femoral arteries (only supply to head of femur).

Question 4

Risk Factors of Hip Fractures.

Answer 4

1. Increasing Age.
2. Female.
3. Osteoporosis.

Question 5

What is an Intracapsular Fracture?

Answer 5

A break in the femoral neck, within the capsule of the hip joint, affecting the area proximal to the intertrochanteric line.

Question 6

Classification of Intracapsular Fractures (4).

Answer 6

Garden Classification :
I - Incomplete + Non-Displaced.
II - Complete + Non-Displaced.
III - Partial Displacement (Trabeculae at Angle).
IV - Full Displacement - (Trabeculae are Parallel).

Question 7

What is the significance of Non-Displaced and Displaced Fractures? (2)

Answer 7

1. Displaced (III/IV) - Disruption to Blood Supply of Head of Femur : REMOVE AND REPLACE HEAD.
2. Non-Displaced : May have an intact supply - internal fixation?

Question 8

What is a Hemiarthroplasty?

Answer 8

Replace the head of the femur but leave acetabulum in place - cement to hold stem of prosthesis in shaft of femur.

Question 9

Indications of Hemiarthroplasty (2).

Answer 9

1. Limited Mobility.

2. Significant Co-Morbidity.

Question 10

What is a Total Hip Replacement?

Answer 10

Replace both head of femur and socket.

Question 11

Indications of Total Hip Replacement (2).

Answer 11

1. Walk Independently.
2. Fit for Surgery.’
3. No Cognitive Impairment.

Question 12

What are Extracapsular Fractures?

Answer 12

Outside the hip joint capsule - no effect on blood supply so no need to replace head of femur.

Question 13

What are the 2 Types of Extracapsular Fractures?

Answer 13

1. Intertrochanteric Fracture (Between Greater and Lesser Trochanter).
2. Subtrochanteric Fracture (Distal within 5cm to Lesser Trochanter = Proximal Shaft).

Question 14

Management of Intertrochanteric Fractures.

Answer 14

Dynamic/Sliding Hip Screw.

Question 15

Management of Subtrochanteric Fractures.

Answer 15

Intramedullary Nail.

Question 16

Stereotypical Patient with Hip Fracture (3).

Answer 16

Over 60 :

1. Pain in Groin/Hip Radiating to Knee.
2. Not Able to Weight Bear (can weight bear in Type I).
3. Shortened, Abducted and Externally Rotated (SABER).

Question 17

Investigations of Hip Fracture (2).

Answer 17

1. Initial - X-Rays (2 Views = AP and Lateral).

2. MRI/CT (2nd Line).

Question 18

What is Shenton’s Line?

Answer 18

A continuous curving line formed by the medial border of the femoral neck continuing to the inferior border of the superior pubic ramus on AP X-Ray Hip.
* Disruption = Sign of NOF Fracture.

Question 19

Main Management of Hip Fracture (3).

Answer 19

1. Surgery within 48 Hours.
2. Allow patient to weight-bear immediately (PT start mobilisation and rehabilitation ASAP).
3. Post-Operative Analgesia (to encourage mobilisation).

Question 20

Additional Management of Hip Fracture (4).

Answer 20

1. Appropriate Analgesia.
2. VTE Prophylaxis.
3. Pre-Operative Assessment.
4. Orthogeriatics Input.

Question 21

Complications of Hip Surgery (6).

Answer 21

1. Anaesthetic Complications.
2. Infection.
3. Loosening of Joint & Hip Dislocation (Posterior).
4. Leg Length Disparity.
5. Thrombosis.
6. Nerve Damage.

Question 22

Aetiology of Posterior Hip Dislocation.

Answer 22

Response to weight-bearing or extreme of flexion (never do Thomas’ Test if Previous Hip Replacement).
* Manual Reduction (or Open Reduction).