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MSK week 6 lectures > Proximal femoral fractures > Flashcards

Proximal femoral fractures Flashcards

1
Q

What has caused an increased incidence of femoral fractures?

A

aging population

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2
Q

who is femoral fractures more common in, male or females ?

A

75% in females

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3
Q

What is the usual mechanism for a femoral fracture and some of the causative factors?

A

Falls:

These could be caused by

  • Cerebrovascular disease
  • Cardiac arrhythmia
  • Postural hypotension

Falls could also just be mechanical

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4
Q

What disease predisposes patients to femoral fractures?

A

Osteoporosis

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5
Q

Despite their being a high risk of mortality and morbidity how are most people treated following a femoral fracture?

A

With surgery - only patients with severe co-morbidities and expected to die not operated on

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6
Q

Following recovery from a femoral fracture what usually happens to the patients mobility ?

A

They usually drop a level of mobility from what they previously were so e.g. if before the used a stick then after they may use 2 sticks

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7
Q

What are some of the surgical complications which can occur following repair of a femoral fracture

A
  • Failure of fixation
  • AVN
  • Non union
  • Infection
  • Dislocation
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8
Q

What are the clincial features which suggest a proximal femoral fracture ?

A
  • Shortening
  • External rotation
  • Trochanteric bruising
  • Unable to SLR
  • Severe groin pain on rotational movements
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9
Q

What are the 3 ways in which a proximal femoral fracture can be classified ?

A
  • Intracapsular
  • Extracapsular
  • Subtrochanteric
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10
Q

What investigation is done for occult ( A fracturethat does not appear in x-rays, although the bone shows new bone formation within three or four weeks of fracture.) prox femur fractures ?

A

MRI

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11
Q

To view an intracapsular fracture correctly what mode of imaging may you need to get?

A

lateral view

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12
Q

When looking at an Xray of an intracapsular femur fractrure how is a diagnosis made?

A

Break in Shenton’s line on X-ray

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13
Q

What type of fracture is shown here?

A

Intracapsular fracture of L femur

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14
Q

What are some of the risks of intracapsular fractures ?

A
  • Risk AVN – 6%. Higher with displaced fractures
  • Non Union – 20%
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15
Q

Is their the risk of AVN in extracapsular fractures?

A

No

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16
Q

What is done to treat extra-capsular fractures?

A
  • Usually heal with sliding hip screw (Dynamic Hip Screw / DHS)
  • Can also fix with intramedullary nail and sliding hip screw (less lever arm)
17
Q

In an extracapsular fracture of the femur there can be 2 part, 3 part or 4 part depending on whether trochanters fractured what does an increase number of parts mean ?

A

increased instability and increased failure rates

18
Q

What are subtrochanteric fractures associated with ?

A

long term bisphosphonate use

19
Q

What are subtrochanteric fractures at a higher risk of ?

A

Blood supply to site less good à higher risk of non- union

20
Q

What is done to treat subtrochanteric fractures?

A
  • Thomas splint may help with analgesia
  • IM nail biomechanically superior – may last longer before breakage if delayed union
21
Q

What is the treatment of Undisplaced intracapsular fracture?

A

Internal fixation with hip screw

22
Q

What is the treatment of Displaced intracapsular in an elderly patient ?

A

Hemiarthroplasty normally used in the elderly to reduce the requirement for a second operation

23
Q

What is the treatment of Displaced intracapsular fracture of the femur in young fit patients?

A

Reduction and internal fixation –> if that fails then you can do a THR if they are medically fit

24
Q

What is the difference between pubic rami fractures and high energy pelvic fractures?

A

They are not as high energy fractures, there is no displacement and bleeding present.

Tender groin, less pain rotation than hip

25
Q

What is the management of the treatment of pubic rami fractures?

A

Conservative

26
Q

what type of fracture is shown?

A

fracture of the R superior pubic rami

27
Q

where is the pubic rami?

A
28
Q

what is the treatment of a greater trochanter fracture ?

A

conservative unless transverse femoral neck then internal fixation

MSK week 6 lectures (5 decks)

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