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Y2 - MSK > Fractures > Flashcards

Fractures Flashcards

1
Q

What are risk factors for hip fractures?

A 
Older (90% 60+)
Young adults with high energy trauma
Female
Smoker
Malnutrition
Excess alcohol
Neurological impairment
Impaired vision
Low BMI
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2
Q

What are the bony features of the proximal femur?

A

Head
Neck
Greater trochanter
Lesser trochanter

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3
Q

What is classed as an intra and extra-capsular hip fracture?

A

Intra - the neck and head of femur

Extra - distal to the neck (including greater and lesser trochanter)

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4
Q

Where does the blood supply to the femoral head come from?

A

Intra-medullary artery of shaft of femur
Medial and lateral circumflex branches of profunda femoris
Artery of ligamentum teres

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5
Q

Which arteries’ blood supply is are cut off in an intra-capsular hip fracture, and which are still intact?

A

Cut off:
- Medial and lateral circumflex branches of profunda femoris
- Intramedullary artery of shaft of femur
Intact:
- Ligamentum teres

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6
Q

Which arteries’ blood supply is are cut off in an extra-capsular hip fracture, and which are still intact?

A

Cut off:
- Intramedullary artery of shaft of femur
Intact:
- Medial and lateral circumflex branches of the profunda femoris
- Ligamentum teres

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7
Q

Which type of proximal femur (hip) fracture is more serious, and why?

A

Intracapsular

Blood supply is cut off - risk of avascular necrosis

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8
Q

What are the different grades of intracapsular hip fractures?

A

Grade 1 - split in surface of neck
Grade 2 - complete break of the neck
Grade 3 - partial displacement of head and neck
Grade 4 - complete displacement of head and neck

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9
Q

What are the different types of intra-capsular hip fractures, based on anatomical position of the fracture?

A

Subcapital - just underneath the head of femur

Transcervical - fracture along middle of neck

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10
Q

What are the different types of extra-capsular hip fractures, based on anatomical position of the fracture?

A

Basicervical - just under the neck
Intertrochanteric - fracture from the greater to lesser trochanter
Subtrochanteric - under both trochanters

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11
Q

When taking history of a hip fracture, what information do you need to know about the injury?

A

Mechanism (mechanical fall or secondary to other cause)

Corroborated history from family member if possible if patient is confused

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12
Q

When taking history of a hip fracture, what information do you need to know about the past medical history?

A 
Relevant conditions e.g.
Diabetes
Bleeding disorders
CVD
Parkinson's
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13
Q

When taking history of a hip fracture, what information do you need to know about the drug history?

A

Medications
Anticoagulation status
Medication changes

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14
Q

When taking history of a hip fracture, what information do you need to know about the social history?

A

Patient’s usual function
Walking aids?
Carers?
Lives in own home?

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15
Q

What needs to be done when examining a patient with hip fracture?

A 
Able to weight bear?
Cognitive impairment?
Look for missed injuries
Fluid status/dehydration
Neurovascular status
Leg usually shortened and externally rotated
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16
Q

What tests can be initially done for a patient with a hip fracture?

A

ECG

Bloods

17
Q

What imaging should be done for a hip fracture?

A

X-ray of pelvis and lateral hip
CXR if pre-existing lung disease
If in doubt - MRI

18
Q

What imaging sign can give a good indication of whether hip fracture is present?

A

Loss of Shenton’s line

can still be normal though

19
Q

What is the management for an intra-capsular hip fracture in a high functioning patient?

A

If displaced - THR

If undisplayed - compression hip screw (CHS)

20
Q

What is the management for an intra-capsular hip fracture in a low functioning patient?

A

Hemi-arthroplasty

21
Q

What is a hemi-arthroplasty?

A

Partial hip replacement - just ball and socket part

22
Q

What is the management for an extra-capsular, inter-trochanteric hip fracture?

A

Dynamic Hip Screw (DHS)

23
Q

What is the management for an extra-capsular, sub-trochanteric hip fracture?

A

Intra-medullary (IM) nail

24
Q

What are the complications of intra-capsular hip fractures?

A 
Non-union
Avascular necrosis
Loss of function
Infection
Medical risk (DVT, PE, MI, CVA)
Dislocation
Periprosthetic fracture
25
Q

What are the complications of extra-capsular hip fractures?

A 
Malunion
Non-union
Loss of function
Infection
Medical risk (DVT, PE, MI, CVA)
Dislocation
Periprosthetic fracture

Y2 - MSK (9 decks)

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