T&O: NOF Fracture

Question 1

Outline the pathophysiology of an NOF Fracture.

Answer 1

Head’s blood supply = uni-directional, medial femoral Cx A (from deep femoral A)

Medial femoral Cx A lies directly on femoral neck = vulnerable to damage in a # (avascular necrosis)

IC = either subcapital (through junction of head/neck) or basocervical fracture (through base of femoral neck)

EC = either intertrochanteric (between two trochanters) or subtrochanteric (<5cm distal to lesser trochanter)

Question 2

Outline the aetiology of an NOF Fracture.

Answer 2

Low energy injuries = fall in frail older patient

High energy injuries = road traffic collision, affecting the ipsilateral side

Question 3

What are the symptoms of an NOF Fracture?

Answer 3

Significant pain

Inability to weight bear

Shortened limb

Externally rotated

Question 4

How would you investigate NOF Fracture?

Answer 4

X-ray = AP/lat

Full neurovascular exam

Bloods = FBC, U+Es, clotting screen, group and save

CXR, ECG, urine dip (older pts)

Question 5

How would you treat an NOF Fracture?

Answer 5

A to E approach = stabilise pts

Analgesia

Surgical

Post-op = under to care the ortho-geriatricians, PT, OT

Question 6

What are the complications of an NOF Fracture?

Answer 6

Joint dislocation

Aseptic loosening

Peri-prosthetic fracture

Mortality = 30% at one year

Question 7

How can an IC NOF # be classified?

Answer 7

The Garden Classification

Question 8

What features should be looked for on x-ray when diagnosing a NOF#

Answer 8

1. Intracapsular vs extracapsular
2. displaced vs undisplaced
3. Shenton’s line = line drawn along the inferior border of the superior pubic ramus (superior border of the obturator foramen) and along the inferomedial border of the neck of femur
4. Osteopenia