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A - MSRA MSK [11] > [1] Hip Fractures > Flashcards

[1] Hip Fractures Flashcards

1
Q

What is a hip fracture?

A

A fracture of the proximal femur

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2
Q

What is considered to be the proximal femur?

A

5cm or less below the lesser trochanter

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3
Q

Why are hip fractures important in the NHS?

A

They are the most common reason for admission onto an orthopedic trauma ward

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4
Q

What are the types of hip fracture?

A
  • Intracapsular fracture
  • Extracapsular trochanteric fracture
  • Extracapsular subtrochanteric fracture
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5
Q

What does an intracapsular fracture involve?

A

The femoral neck between the edge of femoral head and the insertion of the capsule of the hip joint

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6
Q

Where does the break occur in an intracapsular fracture?

A

Below the ball, or in the neck of femur

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7
Q

What complication can arise from intracapsular fractures?

A

They can disrupt the blood supply to the femoral head, leading to avascular necrosis

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8
Q

What proportion of all hip fractures are intracapsular?

A

Around half

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9
Q

What is an extracapsular trochanteric fracture?

A

A fracture that is distal to the insertion of the capsule, involving or between trochanters

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10
Q

What is an extracapsular subtrochanteric fracture?

A

Fractures below, but no more than 5cm below, the lesser trochanter

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11
Q

What does an extracapsular subtrochanteric fracture involve?

A

The proximal femoral shaft at, or just distal to, the trochanters

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12
Q

What are the risk factors for hip fractures?

A
  • Increasing age
  • Osteoporosis
  • Osteomalacia
  • Falls
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13
Q

What factors might falls be secondary to?

A
  • Lack of core strength
  • Instability
  • Gait disturbance
  • Sensory impairment
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14
Q

In who can hip fractures follow a relatively minor trauma?

A
  • Elderly
  • Those with osteoporosis
  • Those with metastatic disease
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15
Q

What causes hip fractures in younger patients?

A

Usually caused by high energy trauma

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16
Q

What are hip fractures in younger patients often associated with?

A

Other serious injuries

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17
Q

How do hip fractures present?

A
  • Pain
  • Inability to weight bear
  • Affected leg may be shorted, adducted, and externally rotated
18
Q

What are the features of the pain in hip fractures?

A

It is typically in the upper outer thigh or in the groin, and may radiate to the knee

It may be aggravated by flexion and rotation of the leg

19
Q

How are hip fractures investigated?

A
  • Imaging
  • General workup
  • Early assessment for cognitive impairment and treatable conditions
20
Q

What is involved in a general workup in hip fracture?

A
  • FBC
  • Crossmatch
  • Renal function
  • Glucose
  • ECG
21
Q

What treatable conditions may be involved in the aetiology of a hip fracture?

A
  • Anaemia
  • Volume depletion
  • Electrolyte imbalance
  • Acute confusional state
  • Uncontrolled diabetes
  • Uncontrolled heart failure
  • Chest infection
22
Q

What imaging is done in hip fractures?

A
  • X-rays
  • MRI
23
Q

What kind of x-rays are done to investigate a hip fracture?

A

AP pelvic and lateral x-rays

24
Q

What may the x-ray show in hip fractures?

A
  • Disruption of trabeculae and inferior or superior cortices
25
Q

What is Shenton’s line?

A

A radiographic, curved line formed by the top of the obturator foramen and the inner side of the neck of the femur.
It is broken in fractures

26
Q

What is Shenton’s line used to determine?

A

The relationship between the head of the femur and the acetabulum

27
Q

When should MRI be performed in hip fractures?

A

If hip fracture is suspected, but AP pelvic and lateral hip x-rays don’t show a fracture

28
Q

When should CT be performed in hip fracture?

A

If MRI is not available within 24 hours or is contraindicated

29
Q

How are intracapsular hip fractures managed?

A

Surgery

30
Q

When should surgery be performed with intracapsular hip fractures?

A

Within 1 day of admission

31
Q

What surgical treatment do undisplaced intracapsular hip fractures need?

A

Internal fixation with screws

32
Q

What surgical treatment do displaced intracapsular hip fractures need?

A

Replacement of the femoral head with an arthroplasty (if the person is fit for the procedure)

33
Q

What is the advantage of internal fixation in the management of hip fractures?

A

It is associated with less initiate operative trauma

34
Q

What is the disadvantage of internal fixation in the management of hip fractures?

A

It has an increased risk of re-operation on the hip

35
Q

When can total hip replacements be used for patients with displaced intracapsular fractures?

A

When patients;

  • Are able to walk independantly out of doors with no more than a stick
  • Are not cognitively impairment
  • Are medically fit for anaesthesia and the operation
36
Q

How are extracapsular hip fractures managed?

A

Surgically, unless there are medical contraindications

37
Q

What is the surgical management for extracaspular hip fractures?

A

Usually treated by internal fixation, but hip arthroplasty may be used

38
Q

Why is hip arthroplasty sometimes used over internal fixation in extracapsular hip fractures?

A

As internal fixation may fail, especially for unstable fractures

39
Q

What is the mortality for hip fractures?

A

High, with about 10% of poeple with hip fracturs during within 1 month, and a third within 12 months.

40
Q

What are the potential complications of hip fractures?

A
  • Infection
  • Haemorrhage
  • Avascular necrosis
  • Delayed union, malunion, and non-union
  • Pneumonia
  • Myocardial infarction
  • Stroke
  • DVT and pulmonary embolus
  • Pressure ulcer

A - MSRA MSK [11] (38 decks)

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