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Year 3 Surgery block > T&O: NOF fractures, hip + femoral shaft > Flashcards

T&O: NOF fractures, hip + femoral shaft Flashcards

1
Q

What is the classifcation for Intracapsular NOF fractures?

A

Garden classification:

Garden I: incomplete and undisplaced fracture

Garden II: Complete but undisplaced fracture

Garden III: Complete fracture with partial displacement

Garden IV: Complete fracture with 100% displacement

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2
Q

What are the 2 most common injuries for NOF fracture?

A

Low energy trauma - osteoperiotic frail older pt -falls

High energy trauma - road traffic accident, fall from height

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3
Q

Which 2 areas can be affected in an extracapsualr NOF fracture?

A

Extracapsular

Inter-trochanteric - between greater and lesser trochanter

Sub-trochanteric - from lesser trochanter to 5 cm distal to this point

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4
Q

The Garden classification for NOF fracutres describes both Intra-capsualr and Extra-capsular fractures

TRUE or FALSE?

A

FALSE

Only for Intracapsular fractures !

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5
Q

Blood supply to the the NOF is ____________ and is supplied by the ___________ which lies directly on the __________. Fracture to the NOF can lead to___________

A

Blood supply to the the NOF is __retrograde__ and is supplied by the _**Medial Circumflex Artery** which lies directly on the _femoral neck_. Fracture to the NOF can lead to__avascular necrosis_.

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6
Q

What are the symptoms / presentation of NOF fracture?

A
  • Severe pain in the hip or groin- may also be in anterior thigh, and elderly may refer to knee
  • Inability to bear weight on the affected leg
  • Shortening and external rotation of the affected leg
  • Swelling or bruising over the hip area
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7
Q

What would you find on examination ?

A

Shortened, externally rotated leg (external rotators: obturator internus, gemelli, piriformis, quadratus femoris)

Test: Pain on pin rolling and axial loading

Neurovascualr : rare to have defecits- but do full exam

investigate injury cause: especially if Hx of injury not clear

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8
Q

What are some differencial diagnosis for NOF fracture?

A

Other fractures :

  • Pelvis - esp. pubic ramus
  • Femoral head / diaphysis
  • acetabulum

Pathological Fractures:

Esp. if no significant trauma

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9
Q

What type of emboli is at risk of forming with a femoral shaft fracture?

A

Fat emboli

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10
Q

Fat emboli gives a classic triad of signs. What are they?

A

Hypoxaemia, neurological abnormalities, petechial rash

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11
Q

What findings would you see on an XR of a child with Perthes’ disease?

A

Femoral head collapse and fragmentation which suggests osteonecrosis.

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12
Q

What is a recognised complication of a total hip replacement?

A

Posterior hip dislocation

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13
Q

What are risk factors following an ORIF surgery?

A

Surgical site infection, DVT or PE, NV injury, non-union, metalwork prominence.

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14
Q

What would be the management for an intertrochanteric NOF fracture?

A

This is an extracapsular break off the femur between the greater and lesser trochanters. Needs DHS.

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15
Q

How do you treat NOF?

A

Garden 1/2- ORIF and cancellous screws
Garden 3/4- depends on age–> <55–> ORIF and screws
>75–> hemiarthroplasty
55-75- total hip replacement

EXTRACAPSULAR- ORIF and DHS

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16
Q

What do we mean by an inter-trochanteric fracture?

A

Between lesser and greater trochanter

17
Q

What is a sub-trochanteric fracture?

A

Fracture from lesser trochanter to 5cm distal to this point

18
Q

How does an extra capsular NOF fracture present?

A

Hx of trauma - high energy or low energy if more elderly. Pain. can not weight bear.

19
Q

What would you see on examination of an extra capsular NOF fracture/intracapsular NOF?

A

Shortened and externally rotated leg. Pain on pin rolling the leg or axial loading.

20
Q

What investigations would you do a suspected extracapsular NOF fracture?

A

XR AP and lateral. FBC< U+E, Coag screen, group and save, CK is suspect rhabdomyolysis . In elderly pt, do urine dip, egg, cxr.

21
Q

What are RF for extra capsular NOF fracture?

A

Being elderly (osteoporotic), stress fractures, trauma. Pathological fractures (have underlying disease meaning bone is brittle) - Paget’s disease, osteomalacia, osteoporosis, osteogenesis imperfecta, bone cancer

22
Q

What is initial management for NOF fracture?

A

A-E assessment + stabilise. Analgesia - opiod or regional fascia - iliac block. if elderly - need to have assessment by ortho-geriatricians. Need to be seen by physio and occupy therapists.

23
Q

What is surgical management for intertrochanteric NOF extracap fracture?

A

DHS - dynamic hip sore. Here - screw into the NOF and side plate fixed screw - compress to cause bone healing.

24
Q

What is surgical management for subtrochanteric NOF extracap fracture?

A

Intramedullary femoral nail - titanium rod is placed through medullary cavity of the demur to help stabilise it.

25
Q

Name 2 immediate post op NOF fracture surgery complications

A

Pain, bleeding, leg length discrepancy, NVS damage

26
Q

What are long term complications of NOF fracture surgery?

A

Joint dislocation, aspect loosening, peri-prosthetic fracture, deep infection, prosthetic joint infection

27
Q

What is level of mortality increased by, at one year post NOF fracture?

A

Up to 30%

28
Q

Define intracapsular NOF fracture

A

Fracture in sub capital region of the femoral head to the basocervical region

29
Q

What surgical management would you consider with a displaced sub capital inter capsular NOF fracture?

A

Hip hemiarthorplasty or total hip arthroplasty if independence and systemically well

30
Q

Pt has non displaced intracapsular NOF fracture that needs to be treated surgically. What surgery would be considered?

A

Cannulated hip screws or a total hip arthroplasty

31
Q

What type of surgery would be done for a basocervical intracap NOF fracture?

A

DHS or total hip arthroplasty if systemically well and independent.

32
Q

What is the most common type of of hip dislocation?

A

Posterior (90%)

33
Q

What is the mechanism of action of a posterior hip dislocation?

A

Dashboard injury

34
Q

How does a posterior hip dislocation present?

A

Internally rotated and slightly flexed and abducted

35
Q

How does an anterior hip dislocation present?

A

Externally rotated, slightly flexed and abducted

36
Q

What is trochanteric bursitis?

A

Inflammation of the bursa overlying the greater trochanter

37
Q

How does trochanteric bursitis present?

A

Lateral hip pain (worse with activity and at night)
Swelling
Positive trendelenburg test

Year 3 Surgery block (66 decks)

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