WCC: hip fractures

Question 1

What questions are important to ask each patient

Answer 1

• Ambulatory status
• Anticoagulation
• Last PO intake
• Comorbidities (cardiopulmonary status, Rhabdomyelitis, etc)

Question 2

This is found on the posterior medial portion of the proximal femur and is an important area of hard cortical bone that provides structural support to the entire hip

Answer 2

Calcar: posteromedial cortex

Question 3

Femoral neck fractures are considered intracapsular . . why is this important

Answer 3

• Blood supply

- most likely disrupted blood flow to the femoral head

Question 4

What is the most significant blood supply to femoral head

Answer 4

-lateral epiphyseal artery off of the medial femoral circumflex

Question 5

Describe the Garden classification for hip fractures

Answer 5

Type I: non displaced incomplete valgus impacted

• Type II: non displaced
• Type III: Complete fracture, partially Displaced Varus
• Type IV: Completely displaced

Question 6

Treatment of type I and II Garden class hip fractures

Answer 6

Cannulated screw in an inverted triangle (important that inferior screw rest on calcar. configuration, sliding hip screw, or cephalomedullary device

Question 7

Treatment of type III and IV Garden class hip fractures

Answer 7

Total or hemi hip arthroplasty

Question 8

Main difference between Gardens I and II vs. III and IV

Answer 8

• Nondisplaced (Blood supply intact)

- Displaced (blood supply disrupted)

Question 9

Describe the Pauwel classification of femoral neck fractures

Answer 9

• Based on angle of fracture
• Type I: <30
• Type II: 30-50
• Type III: >50

Question 10

How are stable intertrochanteric fractures treated

Answer 10

sliding hip screw (same as dynamic hip screw)

Question 11

classification of intertrochanteric fractures

Answer 11

• Evans classification
• Stable: intact posteriomedial cortex; will resist medial compressive loads once reduced
• Unstable: 1: Comminution of posterior medial cortex, will collapse into varus and retroversion when loaded
• Reverse obliquity
• Lateral wall blow out
• Subtrochanterid extension

Question 12

How are unstable intertrochanteric fractures treated

Answer 12

cephalomedullary nail

Question 13

How do you evaluate how good your hardware positioning is when treating an intertrochanteric fx

Answer 13

Tip to apex distance (TID)

-Want a TID less than 25 mm

Question 14

What position will the affected lower extremity be in after a hip fracture

Answer 14

Shortened and externally rotated

Question 15

What is normal femoral neck to shaft angle

Answer 15

130 degrees

Question 16

what x-rays should be ordered when evaluating hip fx

Answer 16

• AP pelvis
• AP hip
• Cross table lateral
• Full length femur

Question 17

what percent of femoral shaft fractures have an associated femoral neck fracture

Answer 17

6-9%

Question 18

What is the most significant determinant of postoperative survival in hip fracture patients

Answer 18

Pre injury mobility

Question 19

Within what time frame should intertrochanteric fx be fixed surgically

Answer 19

48 hours