Proximal femoral fractures Flashcards
What has caused an increased incidence of femoral fractures?
aging population
who is femoral fractures more common in, male or females ?
75% in females
What is the usual mechanism for a femoral fracture and some of the causative factors?
Falls:
These could be caused by
- Cerebrovascular disease
- Cardiac arrhythmia
- Postural hypotension
Falls could also just be mechanical
What disease predisposes patients to femoral fractures?
Osteoporosis
Despite their being a high risk of mortality and morbidity how are most people treated following a femoral fracture?
With surgery - only patients with severe co-morbidities and expected to die not operated on
Following recovery from a femoral fracture what usually happens to the patients mobility ?
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
What are some of the surgical complications which can occur following repair of a femoral fracture
- Failure of fixation
- AVN
- Non union
- Infection
- Dislocation
What are the clincial features which suggest a proximal femoral fracture ?
- Shortening
- External rotation
- Trochanteric bruising
- Unable to SLR
- Severe groin pain on rotational movements
What are the 3 ways in which a proximal femoral fracture can be classified ?
- Intracapsular
- Extracapsular
- Subtrochanteric
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 ?
MRI
To view an intracapsular fracture correctly what mode of imaging may you need to get?
lateral view
When looking at an Xray of an intracapsular femur fractrure how is a diagnosis made?
Break in Shenton’s line on X-ray
What type of fracture is shown here?
Intracapsular fracture of L femur
What are some of the risks of intracapsular fractures ?
- Risk AVN – 6%. Higher with displaced fractures
- Non Union – 20%
Is their the risk of AVN in extracapsular fractures?
No
What is done to treat extra-capsular fractures?
- Usually heal with sliding hip screw (Dynamic Hip Screw / DHS)
- Can also fix with intramedullary nail and sliding hip screw (less lever arm)
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 ?
increased instability and increased failure rates
What are subtrochanteric fractures associated with ?
long term bisphosphonate use
What are subtrochanteric fractures at a higher risk of ?
Blood supply to site less good à higher risk of non- union
What is done to treat subtrochanteric fractures?
- Thomas splint may help with analgesia
- IM nail biomechanically superior – may last longer before breakage if delayed union
What is the treatment of Undisplaced intracapsular fracture?
Internal fixation with hip screw
What is the treatment of Displaced intracapsular in an elderly patient ?
Hemiarthroplasty normally used in the elderly to reduce the requirement for a second operation
What is the treatment of Displaced intracapsular fracture of the femur in young fit patients?
Reduction and internal fixation –> if that fails then you can do a THR if they are medically fit
What is the difference between pubic rami fractures and high energy pelvic fractures?
They are not as high energy fractures, there is no displacement and bleeding present.
Tender groin, less pain rotation than hip
What is the management of the treatment of pubic rami fractures?
Conservative
what type of fracture is shown?
fracture of the R superior pubic rami
where is the pubic rami?
what is the treatment of a greater trochanter fracture ?
conservative unless transverse femoral neck then internal fixation
