Proximal femur fractures

Question 1

What are the risk factors for proximal femur fractures?

Answer 1

Risk doubles every 10 years after age 50 
Females
Smoking
Malnutrition
Excess alcohol
Neurological impairement
Impaired vision

Question 2

What muscles attach at the intertrochanteric line?

Answer 2

Vastus muscles

Question 3

What is the blood supply to the femoral head?

Answer 3

Intramedullary artery of the shaft of femur
Medial and lateral circumflex branches of profunda femoris
Artery of ligamentum teres

Question 4

What are the different types of proximal femoral fractures?

Answer 4

Intracapsular - undisplaced or displaced

Extracapsualr - basicervical, intertrochanteric, subtrochanteric

Question 5

What are the signs of a NOF?

Answer 5

Shortening

External rotation

Question 6

What is a classical x-ray finding of NOF?

Answer 6

Shenton’s line

Question 7

How do intracapsualr fractures tend to be treated?

Answer 7

THR or hemi-arthroplasty

Multiple hip pinning

Question 8

How do extracapsular fractures tend to be treated?

Answer 8

Dynamic hip screw

Intramedullary device

Question 9

How are subtrochanteric fractures treated?

Answer 9

Gamma nail

Question 10

What are the 11 standards of hip fractures in hospital?

Answer 10

Be treansferred from ED to ortho ward within 4 hours
Big six intervention in ED
Recieve inpatient bundle or care within 24 hours
Undergo surgery within 36 hours
Not be fasted repeatedly
Have a cemented hemiarthroplasty unless otherwise indicated
Reieve a geriatric assessment within 3 days

Question 11

What is the big six interventions?

Answer 11

Analgeisa
Optimising fluid/balance electrolyte 
Pressure area assessment
NEWS
Cognition screening
Bloods
Screening for delirium

Question 12

What pre-op analgesia should be given in NOF#?

Answer 12

Local nerve block

Question 13

What can be used to assess delirium?

Answer 13

Confusion assessment model
Acute change/ fluctuating cognitive level
Inattention
Altered conscious level 
4AT tool

Question 14

How can delirium be managed?

Answer 14

Predisposing factors - age, demetia
Precipitating factors - pain, drugs, constipation
Propagating factors - change in environment, constipation, infection
Non-pharma methods - ensure orientation, same nursing team, use families

Question 15

What is the inpatient bundle of care?

Answer 15

Cognitive
Nutritional - MUST
Pressure area
Falls

Question 16

What is included in a geriatric assessment?

Answer 16

Ongoing analgeisa
Fluid/electrolyte balance inc blood transfusion for anaemia
Co-morbin condition management inc medication review
Prevention, indentification and management of delirium
Prevention of complications infection, DVT, pressure ulcers
Early identification and treatment of complications
Falls assessment

Question 17

What is frailty syndrome?

Answer 17

Falls 
Immobility
Delirium
Incontinence
Susceptibility to side effects of medication (confusion with codeine, hypotension with antidepressants)

Question 18

What is the CSHA frailty scale?

Answer 18

Very fit 
Well
Well with treated co morbid disease
Apparently vulnerable
Midly frail
Moderately frail
Severely frail

Question 19

What are the side effects of opiods?

Answer 19

Drowsiness
Confusion
Constipation
Dizziness

Question 20

What is the pragmatic approach to post op analgesia in NOF?

Answer 20

Paracetamol oral or IV
Codeine small starting dose
Morphine as required
Oxycodone if morphine not tolerated

Question 21

What is included in a falls assesment?

Answer 21

Falls history
Examination: visual assessment, cardio, neurology and MSK
Medication review
ECG

Question 22

What bone assessment should be done in NOF#?

Answer 22

Calcium/ vit D intake
DeXA
Oral alendronic acid one weekly
IV bisphosphonates if needed