Proximal femur fractures Flashcards
What are the risk factors for proximal femur fractures?
Risk doubles every 10 years after age 50 Females Smoking Malnutrition Excess alcohol Neurological impairement Impaired vision
What muscles attach at the intertrochanteric line?
Vastus muscles
What is the blood supply to the femoral head?
Intramedullary artery of the shaft of femur
Medial and lateral circumflex branches of profunda femoris
Artery of ligamentum teres
What are the different types of proximal femoral fractures?
Intracapsular - undisplaced or displaced
Extracapsualr - basicervical, intertrochanteric, subtrochanteric
What are the signs of a NOF?
Shortening
External rotation
What is a classical x-ray finding of NOF?
Shenton’s line
How do intracapsualr fractures tend to be treated?
THR or hemi-arthroplasty
Multiple hip pinning
How do extracapsular fractures tend to be treated?
Dynamic hip screw
Intramedullary device
How are subtrochanteric fractures treated?
Gamma nail
What are the 11 standards of hip fractures in hospital?
Be treansferred from ED to ortho ward within 4 hours
Big six intervention in ED
Recieve inpatient bundle or care within 24 hours
Undergo surgery within 36 hours
Not be fasted repeatedly
Have a cemented hemiarthroplasty unless otherwise indicated
Reieve a geriatric assessment within 3 days
What is the big six interventions?
Analgeisa Optimising fluid/balance electrolyte Pressure area assessment NEWS Cognition screening Bloods Screening for delirium
What pre-op analgesia should be given in NOF#?
Local nerve block
What can be used to assess delirium?
Confusion assessment model Acute change/ fluctuating cognitive level Inattention Altered conscious level 4AT tool
How can delirium be managed?
Predisposing factors - age, demetia
Precipitating factors - pain, drugs, constipation
Propagating factors - change in environment, constipation, infection
Non-pharma methods - ensure orientation, same nursing team, use families
What is the inpatient bundle of care?
Cognitive
Nutritional - MUST
Pressure area
Falls
What is included in a geriatric assessment?
Ongoing analgeisa
Fluid/electrolyte balance inc blood transfusion for anaemia
Co-morbin condition management inc medication review
Prevention, indentification and management of delirium
Prevention of complications infection, DVT, pressure ulcers
Early identification and treatment of complications
Falls assessment
What is frailty syndrome?
Falls Immobility Delirium Incontinence Susceptibility to side effects of medication (confusion with codeine, hypotension with antidepressants)
What is the CSHA frailty scale?
Very fit Well Well with treated co morbid disease Apparently vulnerable Midly frail Moderately frail Severely frail
What are the side effects of opiods?
Drowsiness
Confusion
Constipation
Dizziness
What is the pragmatic approach to post op analgesia in NOF?
Paracetamol oral or IV
Codeine small starting dose
Morphine as required
Oxycodone if morphine not tolerated
What is included in a falls assesment?
Falls history
Examination: visual assessment, cardio, neurology and MSK
Medication review
ECG
What bone assessment should be done in NOF#?
Calcium/ vit D intake
DeXA
Oral alendronic acid one weekly
IV bisphosphonates if needed
