Week 6 - F - Regional Adult Trauma (5) - Hip and proximal,distal & femoral shaft fractures Flashcards
Who do hip fractures usually affect? What gender is more commonly affected?
Commonly affect the osteoporotic elderly population
Majority of those affected by a hip fracture are female - majority are over 80 with whom 75% are female
Many patients have significant co‐morbidites (cerebrovascular insufficiency, cardiac arrhythmias, postural hypotension etc.) which contribute to their risk of falling. What are mortality rates from hip fractures at one, four and 12 months?
At one months - around 10%
At four months - around 20%
At twelve months - around 30%
Despite the risk of medical complications with surgery, nearly all patients with a hip fracture undergo surgery as the risks of non‐operative management are just as high What are cons of non operative management of hip fractures?
Prolonged bed rest may lead to wasting of the muscles and
pressure ulcer formation and
the fracture may not heal
To maximize the chance of restoration of function and to promote early mobilization almost all hip fractures undergo surgery within the first 24 hours what are the type of patinets who do not undergo surgery for hip fractures?
Patients who are expected to die soon after the injury
Hip fractures are broadly classified as being intracapsular or extracapsular. What are the intracapsular and extracaspular in reference to?
In reference to the capsule of ligaments that form a spiral to strengthen the hip joint
What is the artery that branches of the femoral artery soon after its origin? What is the femoral artery a continuation of and what does it travel beneath?
The profunda femoris (deep femoral artery) is the branch of the femoral artery
Femoral artery is a continutation of the external iliac artery and passes benath the inguinal ligament
What are the branches of the deep femoral artery that anastamose to supply the head and neck of the femur?
These are the medial and lateral circumflex arteries
Anastamose to form the retinacular arteries
What is the foveolar artery (artery of ligamentum teres a branch of)?
It is a branch of the obturator artery
Hip fractures can be split into intra and extra capsular fractures What is disrupted in intracapsular fractures?
The arterial supply to the head of the femur and therefore avascular necrosis of the femoral head can occur
What can avascular necrosis of the femoral head cause in terms of fracture healing?
This can cause non-union of the fracture (specifically atrophic non-union)
How are intracapsular fractures of the hip treated?
Usually with total hip replacement or hemi-arthroplasty (or internal fixation with a cannulated hip screw if undisplaced young and mobile )
Hemi arthroplasty involves only replacing the femoral head
Total hip replacement involves replacing the acetabulum and femoral head
Which type is preferred as it gives better function however is only reserved for higher functioning patients? What is the main side effect
Totl hip replacement basically preferred for younger more active patients
However THR has increased dislocation rate as it is a smaller head
What type of patient is hemi-arthroplasty preferred for?
Hemi-arthroplasty is preferred for patinets with restricted mobility and the cognitively impaired patient
Do extracapsular hip fractures cause avascular necrosis of the femoral head and therefore affect union?
Extracapsular hip fractures should not cause avascular necrosis and have a high union rate.
How should extracapsular hip fractures therefore be treated as they do not cause avascular necrosis?
Should be treated with internal fixation using compression or a dynamic hip screw
How does a treated extracapsular hip fracture usually heal?
The fracture usually heals in a shortened position
Subtrochanteric fractures also usually occur in the elderly patient with osteoporosis and a fall onto the side. What is bad for prognosis regarding subtrochanteric proximal femur fractures?
They have a less good blood supply and therefore an increased risk of non-union
What may be used for preoperative stabilisation and pain relief and what is the definitve treatment in a subtrochanteric hip fracture?
Use thomas splint for pain relief
Intramedullary nail for fixation is recommended
Femoral shaft fractures usually occur as high energy injuries and as such there a substantial risk of concomitant fracture elsewhere. What can a displaced femoral shaft fracture bring about the risk of?
Can bring about the risk of substantial blood loss and also fat from the medullary canal can enter the damaged venous system resulting in fat embolism
Femoral shaft fractures require the same treatment as subtrochanteric fractures What is this treatment?
Thomas splint for pain relief and stabilisation
Closed reduction and stabilisation with an intramedullary nailing as fixation for definitve treatment
Pubic rami fractures are usually low energy and occur in the elderly How are they treated?
Usually treated conservatively
Distal femur fractures usually occur in osteoporotic bone with a fall onto the flexed knee. How can distal femur fractures be classified?
Fractures can be extra-articular (supracondylar) or intra-articular (intercondylar)
What position does the distal femoral fracture usually attach and why? How are distal femoral fractures usually treated?
Usually adopts a flexed position due to the pull of the gastrocnemius
Treated with a plate and screws as it is difficult to maintain in a cast
What is the origin of the gastrocnemius muscle?
It arises superior to articular surfaces of the medial and lateral condyles
