Y5 - Hip: Fracture (neck of femur, pelvic, pubic ramus)

Question 1

most common cause of a hip fracture

Answer 1

a fall

Question 2

risk factors

Answer 2

osteoporosis
alcohol use
metastatic cancer
age

Question 3

epidemiology

Answer 3

women>men

15% lifetime risk

Question 4

symptoms

Answer 4

Hx of a low energy fall
groin pain
unable to weight bare

Question 5

signs

Answer 5

referred pain to the supracondylar knee

affected leg is shortened and externally rotated

Question 6

anatomy of the hip

Answer 6

the enarthrodial joint (ball and socket) connects to the acetabulum of the pelvis, (which is lined by the labrum)

Question 7

what muscle tendon surrounds the entire joint

Answer 7

psoas muscle

Question 8

what three ligaments surround the entire joint

Answer 8

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

Question 9

what ligament resists internal rotation and adduction

Answer 9

ischiofemoral ligament

Question 10

what ligament resists external rotation and abduction

Answer 10

pubofemoral ligament

Question 11

investigations

Answer 11

xray (AP and lateral view)

MRI is next choice of investigation

Question 12

what direction of fall commonly causes a hip fracture

Answer 12

a sideways fall

Question 13

what are the two main types of hip fracture

Answer 13

intracapsular

extracapsular

Question 14

what are the two ares of intracapsular hip fracture

Answer 14

femoral head
femoral neck
-subcapital
-transcervical
-basicervical

Question 15

what are the different types of femoral neck fracture

Answer 15

subcapital
transcervical
basicervical

Question 16

what classification system is used for femoral head fractures

Answer 16

pipkin classification

Question 17

what classification systems are used for femoral neck fractures

Answer 17

garden classification

pauwels classification

Question 18

what are the two types of extracapsular hip fractures

Answer 18

tronchanteric

subtrochanteric

Question 19

what are the different types of trochanteric fractures

Answer 19

intertrochanteric (between greater and lesser trochanter)

pertrochanteric (through the trochanters)

Question 20

how are intracapsular fractures managed

Answer 20

surgery - fixation with in situ screws

with displaced intracapsular fractures - a hemiarthroplasty

Question 21

how are trochanteric fractures managed

Answer 21

surgery - dynamic hip screw

Question 22

complications

Answer 22

nonunion (failure of the fracture to heal)
malunion (healing in a distorted position)
avascular necrosis is common in intracapsular fractures

Question 23

prognosis

Answer 23

one month mortality is 10%

one year mortality is 30%

Question 24

epi

Answer 24

women>men
white>blicks
elderly

Question 25

what bones form the pelvis

Answer 25

ischium
ilium
pubis

Question 26

how do pelvic fractures occur

Answer 26

high-energy trauma (car crash, falls from height)

Question 27

epi of pelvic fractures

Answer 27

from major trauma

less severe pelvic fractures are generally in elderly

Question 28

signs of pelvic fractures

Answer 28

tenderness, bruising, swelling
haematuria
rectal bleeding
haematoma
instabilty on hip adduction and pain on hip movement

Question 29

what are common classifications for hip fractures

Answer 29

Tile

Young-Burgess

Question 30

epi of pelvic fractures

Answer 30

from major trauma

less severe pelvic fractures are generally in elderly

Question 31

signs of pelvic fractures

Answer 31

tenderness, bruising, swelling
haematuria
rectal bleeding
haematoma
instabilty on hip adduction and pain on hip movement

Question 32

what are common classifications for hip fractures

Answer 32

Tile

Young-Burgess