Proximal Femoral Fracture Flashcards
How many cm under the lesser trochanter is it then classed as femoral shaft fractures?
5 CM
Causes:
What bone disease could cause this?
Without pathology, what is usually needed to cause such as fracture?
Osteoporosis
High energy impact
What symptoms will they have?
What 2 signs would you see on the affected leg?
Groin pain
Unable to bear their weight
Shortened
Externally rotated leg
History:
Why do you need to work out the mechanism of injury?
If it was low impact, there is a likely pathology - OP
Examination:
The deep peroneal nerve can be affected. Where should be checked for paraesthesia?
1st and 2nd toe web space
X-ray of the pelvis (AP) and lateral hip:
There should be a continuous line between running on the medial side of the femur. What is this line called?
A shortened leg will affect the position of the lesser trochanter. Will the lesser T be higher or lower on XR?
How will external rotation change the view of the lesser T?
Shenton’s line - look up
Higher and more prominent if externally rotated
X-ray of the pelvis (AP) and lateral hip:
How do you know whether a fracture is intracapsular?
Extracapsular is obviously the opposite of above!
Garden classification is used to grade intracapsular fractures. What is used to differentiate the fractures?
If it is ABOVE the intertrochlear line - NOT ON THE LINE ITSELF
If there is any displacement
Pre-surgical investigations;
Think of what blood should be done?
What imaging or bedside tests should be done?
FBC
U+E
Coag
Group and save
CXR
ECG
Management:
Benefits of surgery:
- It prevents AVN. What is that?
- What other complications would it prevent?
Avascular necrosis
DVT
Non-union
Management - Replacement arthroplasty:
What type of fracture is this used for?
Why does avascular necrosis happen?
They basically replace the femoral head. What is this called? - this is MORE COMMON
When is a total hip replacement done?
Displaced intracapsular fractures
Circumflex arteries which supply the head sit on the femoral neck
Hemiarthroplasty - hemi because you can replace the acetabulum
If the patient has been independent, has good functional status or has OA
Management - Screws:
What type of fracture is this used for? - 2
A DHS is done. What does this stand for?
Why is this also done for intracapsular fractures in those <50?
When is an intramedullary hip screw (aka intramedullary hip nail) used?
Undisplaced intracapsular fractures
Extracapsular fractures
Dynamic hip screw
Because they will need a further joint replacement in the future if they had an arthroplasty.
So it is better to preserve their own hip as long as possible.
DOWNSIDE - they need to be on crutches for months to allow healing
In subtrochanteric or femoral shaft fractures
Complications of surgery:
Why could they get a PE?
What other complications can happen post-operatively?
Due to a fat embolism
Infection
Poor bone haling
Non-union/malunion
Unequal leg length (post-arthroplasty)
Posterior hip dislocation - how does this tend to happen?
Front-seat passengers with their knees/legs on the dashboard
