Proximal Femoral Fractures Flashcards
who do femoral fractures most commonly affect?
most are elderly and female
usually due to high energy trauma if in young adults
risk factors for proximal femoral fractures?
risk doubles every 10 yrs after age 50 osteoporosis female smoking malnutrition alcohol neurological impairment impaired vision
describe the bony anatomy of the femur
femoral head femoral neck greater trochanter - intertrochanteric line = anterior - intertrochanteric crest = posterior lesser trochanter subtrochanteric region
describe the blood supply to the femoral head
intramedullary artery of shaft of femur
medial and lateral circumflex branches of profundal femoris
artery of ligamentum teres
describe intracapsular femoral fractures
can disrupt blood supply so AVN risk
types of intracapsular fracture?
undisplaced
displaced
garden 1-4 fractures
where does an intracapsular fracture occur?
above the intertrochaneric line
what are the types of extracapsular fracture?
basicervical
intertrochanteric
subtrochanteric
what are the risks with intracapsular fractures?
non-union (20%)
AVN (6%)
what are the risks with extracapsular fracture?
malunion
non-union
rare as blood supply rarely affected
how is a proximal femoral fracture diagnosed?
history - fall, pain, unable to weight bear
signs - shortening and external rotation of the limb
investigations - X ray (shows shentons line), MRI
what is shentons line?
sign on X ray indicating proximal femoral fracture
line from shaft of femur going up and joining with pubis - should be a smooth curve
where does the joint capsule attach?
at the trochanters of the femur
investigation of choice for complex/difficult fractures?
MRI
most successful management of a proximal femur fracture?
surgery and early mobilisation
