2: Proximal femoral fractures

Question 1

Who tends to have proximal femoral fractures?

Answer 1

Elderly women

Question 2

“Proximal femoral” basically means ___ fracture.

Answer 2

hip

Question 3

What are some risk factors for hip fracture?

Answer 3

Age

Osteoporosis

Smoking, alcohol

Malnutrition

Neuro, vision impairments

Question 4

The risk of having a hip fracture ___ every 10 years after age 50.

Answer 4

doubles

Question 5

Osteoporosis is more common in (men / women).

Answer 5

women

Question 6

What is the proximal attachment of the vastus muscles?

Answer 6

Intertrochanteric line (anteriorly)

Question 7

What is the equivalent of the intertrochanteric line posteriorly?

Answer 7

Intertrochanteric crest

Question 8

The region below the greater and lesser trochanters is called the ___ region.

Answer 8

subtrochanteric

Question 9

What does the hip capsule attach to

a) anteriorly
b) posteriorly?

Answer 9

a) Intertrochanteric line

b) Halfway up femoral neck (leaves a bit of space - important)

Question 10

How does bone gain nutrition

a) within the capsule
b) within the joint?

Answer 10

a) Blood vessels from capsule

b) Synovial fluid

Question 11

Which arteries supply the neck of the femur?

Answer 11

Deep femoral artery - medial and lateral circumflex arteries

Question 12

What are the two types of proximal femoral fracture?

Answer 12

Intracapsular

Extracapsular

Question 13

What other blood vessels, apart from the medial and lateral circumflex arteries, supply the neck of the femur?

Answer 13

Intramedullary arteries

Question 14

What is a major complication of intracapsular fractures?

Answer 14

Loss of blood supply

Question 15

Do extracapsular fractures disrupt blood supply?

Answer 15

Not enough to cause problems

Question 16

How are intracapsular fractures further classified?

Answer 16

Undisplaced

Displaced (poor prognosis for healing)

Question 17

What system is used to classify intracapsular fractures?

Answer 17

Garden system

Question 18

How are extracapsular fractures further classified?

Answer 18

Basicervical (along base of neck / true neck of femur, look intracapsular but aren’t)

Intertrochanteric (along “ line)

Subtrochanteric

Question 19

What are some complications of intracapsular fractures?

Answer 19

NON-UNION

Avascular necrosis

Question 20

What is a possible complication of extracapsular fractures?

Answer 20

Malunion leading to poor functional outcome

Question 21

What tends to cause a proximal femoral fracture?

What will the patient’s symptoms be following it?

Answer 21

Falls

Pain

Inability to weight bear on that side

Question 22

What are some clinical signs of a proximal femoral fracture?

Answer 22

Limb shortening

External rotation of hip

Inability to SLR

Question 23

How are suspected proximal femoral fractures investigated?

Answer 23

X-ray

MRI scan

Question 24

Which line is interrupted on an AP X-ray in proximal femoral fractures?

Answer 24

Shenton’s line

Question 25

If you're not sure if there's a fracture after looking at an X-ray, what should you do?

Answer 25

**Get a lateral X-ray / another view**

Question 26

In young people or active older people, the preferred management for undisplaced fractures is...

Answer 26

**fixation** e.g dynamic hip screws,

Question 27

What is the management of hip fractures in old, inactive patients?

Answer 27

Usually **THR**

Question 28

What is a possible complication of THR?

Answer 28

**Higher dislocation rate** than hemiarthroplasty

Question 29

What is the name for half a joint replacement, sometimes given to patients with displaced intracapsular fractures?

Answer 29

**Hemiarthroplasty**

Question 30

Hip replacement is generally more reliable than hemiarthroplasty. When is the latter indicated?

Answer 30

**Patients with really poor function / cognitive deficit**

Question 31

Extracapsular fractures always have a good ___ potential.

Answer 31

**healing**

Question 32

Do extracapsular fractures demand a hip replacement?

Answer 32

**No, will always heal**

Question 33

How are extracapsular fractures treated?

Answer 33

**Reduction ⇒ Fixation** as before, e.g dynamic hip screws, intramedullary nails

Question 34

What does basicervical mean when referring to extracapsular fractures?

Answer 34

**BASE of NECK of femur**

Question 35

What extends into the shaft of the femur and can be used to stabilise extracapsular fractures?

Answer 35

**Intramedullary nail**

Question 36

What is the main goal of treatment after hip surgery?

Answer 36

**Early mobility** to avoid pneumonia, pressure sores, UTIs and joint stiffening