Y5 - Hip: Fracture (neck of femur, pelvic, pubic ramus) Flashcards
most common cause of a hip fracture
a fall
risk factors
osteoporosis
alcohol use
metastatic cancer
age
epidemiology
women>men
15% lifetime risk
symptoms
Hx of a low energy fall
groin pain
unable to weight bare
signs
referred pain to the supracondylar knee
affected leg is shortened and externally rotated
anatomy of the hip
the enarthrodial joint (ball and socket) connects to the acetabulum of the pelvis, (which is lined by the labrum)
what muscle tendon surrounds the entire joint
psoas muscle
what three ligaments surround the entire joint
iliofemoral ligament located anteriorly which prevents hip hyperextension
pubofemoral ligament located anteriorly but deep to the iliofemoral ligament and resists abduction, extension, and external rotation
ischiofemoral ligament on the posterior side which resists extension, adduction, and internal rotation
what ligament resists internal rotation and adduction
ischiofemoral ligament
what ligament resists external rotation and abduction
pubofemoral ligament
investigations
xray (AP and lateral view)
MRI is next choice of investigation
what direction of fall commonly causes a hip fracture
a sideways fall
what are the two main types of hip fracture
intracapsular
extracapsular
what are the two ares of intracapsular hip fracture
femoral head femoral neck -subcapital -transcervical -basicervical
what are the different types of femoral neck fracture
subcapital
transcervical
basicervical
what classification system is used for femoral head fractures
pipkin classification
what classification systems are used for femoral neck fractures
garden classification
pauwels classification
what are the two types of extracapsular hip fractures
tronchanteric
subtrochanteric
what are the different types of trochanteric fractures
intertrochanteric (between greater and lesser trochanter)
pertrochanteric (through the trochanters)
how are intracapsular fractures managed
surgery - fixation with in situ screws
with displaced intracapsular fractures - a hemiarthroplasty
how are trochanteric fractures managed
surgery - dynamic hip screw
complications
nonunion (failure of the fracture to heal)
malunion (healing in a distorted position)
avascular necrosis is common in intracapsular fractures
prognosis
one month mortality is 10%
one year mortality is 30%
epi
women>men
white>blicks
elderly
what bones form the pelvis
ischium
ilium
pubis
how do pelvic fractures occur
high-energy trauma (car crash, falls from height)
epi of pelvic fractures
from major trauma
less severe pelvic fractures are generally in elderly
signs of pelvic fractures
tenderness, bruising, swelling haematuria rectal bleeding haematoma instabilty on hip adduction and pain on hip movement
what are common classifications for hip fractures
Tile
Young-Burgess
epi of pelvic fractures
from major trauma
less severe pelvic fractures are generally in elderly
signs of pelvic fractures
tenderness, bruising, swelling haematuria rectal bleeding haematoma instabilty on hip adduction and pain on hip movement
what are common classifications for hip fractures
Tile
Young-Burgess
