Proximal Femur Fractions Flashcards
What is the epidemiology of proximal femur fractures?
More than 6,000 per year in Scotland = 92% patients > 60, 73% are female
95% get surgery= 30% mortality at one year
How do young people get proximal femur fractures?
High energy trauma = different treatment ethos
How does the risk of proximal femur fractures change with age?
Risk doubles every decade after age 50
What are some risk factors for proximal femur fractures?
Osteoporosis = 3x more common in females
Smoking, malnutrition, excess alcohol, neurological impairment, impaired vision
What is the blood supply to the femoral head?
Intramedullary artery of shaft of femur, medial and lateral circumflex branches of profunda femoris, artery of ligamentum teres
What are the main types of proximal femur fractures?
Intracapsular = disturb circumflex arteries and therefore major blood supply Extracapsular = majority of blood supply preserved
What are the types of intracapsular fractures?
Displaced or undisplaced
What is the Garden classification of intracapsular fractures?
Type A = valgus impacted
Type B = undisplaced
Type C and D = displaced, treated with replacement
What are the types of extracapsular fractures?
Basicervical, intertrochanteric, subtrochanteric
What do intracapsular fractures carry a higher risk of?
Avascular necrosis and non-union
What are the history and signs of a proximal femur fracture?
History = fall, pain, unable to weight bear Signs = shortening, external rotation (only for displaced)
What investigation last can be done for proximal femur fractures?
X-ray = disturber shenton’s line MRI = shows undisplaced
What is the treatment for undisplaced intracapsular fractures?
Depends on function = good function gets fixation with DHS/screws
Why are patients who get screws/DHS for undisplaced intracapsular fractures monitored for two years post-op?
Their injury carries a risk of damaged blood supply and non-union
How are displaced intracapsular fractures treated?
Replacement = hemi or total arthroplasty
Patients with low function get hemi-arthroplasty
How may young patients with displaced intracapsular fractures be treated?
Fixation with screws or DHS
How are extracapsular fractures treated in general?
Fixation = has good blood supply
How are intertrochanteric and basicervical extracapsular fractures treated?
Compression/dynamic hip screws (C/DHS)
How are subtrochanteric extracapsular fractures treated?
Intermedullary nail
How are reverse oblique extracapsular fractures treated?
Type of subtrochanteric fracture so intramedullary nails
Why can’t reverse oblique extracapsular fractures be treated with a DHS?
DHS will most likely fail as fracture direction isn’t perpendicular to compression (will just slip off)
