T&O: Hip Fractures Flashcards
Describe the radiographic features o NOF fractures.
- Shenton’s line disruption
- Increased prominence of lesser trochanter (due to external rotation of femur)
- Femur often position in flexion and external rotation (due to unopposed iliopsoas)
- Sclerosis in fracture plane, smudgy from impaction
What are the 3 levels at which NOFs can occur?
- Subcapital: femoral head/neck junction
- Transcervical: midportion of femoral neck
- Basicervical: base of femoral neck
Describe the different treatment options for NOF fractures.
- Conservative
- Internal fixation
- e.g. dynamic hip screw, crossed screw-nails, dynamic screw + plate
- recommended for young, otherwise fit Pts with small risk of AVN
- associated with higher risk of non-union, AVN and re-operation - Prosthetic replacement
- e.g. hemiarthroplasty ot total hip arthroplasty
- for fractures at high risk of AVN and the elderly
Describe the system used to classify subcapital NOF fractures.
Garden classification predicts development of AVN:
Stage 1 - undisplaced incomplete. Stable, can be treated with internal fixation.
Stage 2 - unidisplaced complete. Stable, can be treated with internal fixation.
Stage 3 - complete fracture, incompletely displace. Unstable, treated with arthroplasty.
Stage 4 - complete fracture, completely displace. Unstable, treated with arthroplasty.
Suggest possible complications of NOF fractures.
- Non-union
- AVN (50% risk in subcapital, 25% risk in transcerical/basicervical) - damage to medial femoral circumlex artery (lies directly on NOF)
- Post-op infection
- Dislocation
What is the 1 yr survival rate for NOF fracture patients?
70-80%
Is prognosis of trochanteric fractures better or worse than for NOF fractures?
Generally have good prognosis as are extracapsular fractures (intertrochanteric or subtrochanteric) with good blood supply and adequate collateral circulation - low incidence of AVN and non-union.
How would you surgically manage a Pt with an intertrochanteric or sutrochanteric fracture?
Intertrochanteric: dynamic hip screw
Subtrochanteric: intramedullary femoral nail
Which investigations would you perform on a Pt presenting with hip fracture?
- Bloods:
- FBC
- UandE
- glucose
- coagulation screen
- group and save - Bedside tests:
- ECG - Imaging:
- pelvis and femur X-ray
- chest X-ray
How would you clinically diffferentiate a hip fracture from a dislocation?
Fracture: leg is shortened and externally rotated
Posterior dislocation (85%): leg is shortened, flexed and internally rotated
Anterior dislocation (10%): leg is externally rotated
Name 3 possible complications of hip dislocation.
- Sciatic n. damage (10-20%)
- Avascular necrosis (esp. if reduction delayed >24hrs)
- Osteoarthritis (if cartilage damage)