FN: Hip Fracture Flashcards Preview

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Flashcards in FN: Hip Fracture Deck (30):
1

Epi

80/100,000
50% in >80 yrs
F>M = 3:1

2

Epi

80/100,000
50% in >80 yrs
F>M = 3:1

3

Pathophysiology

Old = osteoporosis with minor trauma (e.g. fall)
Young = major trauma

4

Osteoporosis risk factors: Age + SHATTERED

Steroids
Hyper-para/thyroidism
Alcohol and Cigarettes
Thin (BMI

5

Presnetation O/E

Shortened and externaly rotated
Key Q's:
1. Mechanims
2. RF for osteoporosis/pathological fractures
3. Premorbid mobility
4. Premorbid independence
5. Cormorbidities
6. MMSE

6

Initial Management

- Resuscitate: dehydration, hypothermia
- Analgesia M+M
- Assess: AP and lateral films
- Prep for theatre

7

Prepping for theatre

Inform Aneasthetist and book theatre
Bloods: FBC, U+E, clotting, X-match (2u)
CXR
DVT prophylaxis: TEDS, LMWH
ECG
Films: orthogonal X-rays
Get consent

8

Imaging

Ap and latweral fimls
Look @ Shentons lines
Intra or extra capsular
Displaced or nondisplaced
Osteopaenic

9

Key Anatomy

1. Capsule attaches proximally to acetabular margin and distaly to intertrochanteric line
2. Blood supply to femoral head
- Retinacular vessels, incapsule, distal - proximal
- Intramedullary vessels
- Artery of ligamentum teres

3. If retinacular vessels damaged there is risk of AVN of the femoral head - pain, stiffness and OA

10

Classification

Intracapsular: subcapital, transcervical, basicervical

Extracapsular: Intertrochanteric, subtrochanteric

11

Classification

Garden classification

12

Garden Classification of intracapsular Fractures

1. Incomplete fractures undisplaced
2. Complete fractures undisplaced
3. Complete fracture partially displaced
4. Complete fracture completely displaced

13

Surgical Management Intracapsular 1,2

1,2: ORIF with cancellous screws

14

Intracapsular Mx 3,4:

15

Pathophysiology

Old = osteoporosis with minor trauma (e.g. fall)
Young = major trauma

16

Osteoporosis risk factors: Age + SHATTERED

Steroids
Hyper-para/thyroidism
Alcohol and Cigarettes
Thin (BMI

17

Presnetation O/E

Shortened and externaly rotated
Key Q's:
1. Mechanims
2. RF for osteoporosis/pathological fractures
3. Premorbid mobility
4. Premorbid independence
5. Cormorbidities
6. MMSE

18

Initial Management

- Resuscitate: dehydration, hypothermia
- Analgesia M+M
- Assess: AP and lateral films
- Prep for theatre

19

Prepping for theatre

Inform Aneasthetist and book theatre
Bloods: FBC, U+E, clotting, X-match (2u)
CXR
DVT prophylaxis: TEDS, LMWH
ECG
Films: orthogonal X-rays
Get consent

20

Imaging

Ap and latweral fimls
Look @ Shentons lines
Intra or extra capsular
Displaced or nondisplaced
Osteopaenic

21

Key Anatomy

1. Capsule attaches proximally to acetabular margin and distaly to intertrochanteric line
2. Blood supply to femoral head
- Retinacular vessels, incapsule, distal - proximal
- Intramedullary vessels
- Artery of ligamentum teres

3. If retinacular vessels damaged there is risk of AVN of the femoral head - pain, stiffness and OA

22

Classification

Intracapsular: subcapital, transcervical, basicervical

Extracapsular: Intertrochanteric, subtrochanteric

23

Classification

Garden classification

24

Garden Classification of intracapsular Fractures

1. Incomplete fractures undisplaced
2. Complete fractures undisplaced
3. Complete fracture partially displaced
4. Complete fracture completely displaced

25

Surgical Management Intracapsular 1,2

1,2: ORIF with cancellous screws

26

Intracapsular Mx 3,4:

75: hemiarthroplasty
- mobilses = cemented thompsons
- non-mobilser: cemented Austin Moore

27

Extracapsular Mx

ORIF with DHS

28

Discharge invovles

OT and Physios
Discharge when mobilsation and social circumstances permit

29

Specific complications

AVN of femoral head in displaced fractures (30%)
Non/mal-union (10-30%)
Infection
Osteoarthritis

30

Prognosis

30% mortality @ 1ye
50% never regain pre=borbid functioning
>10% unable to return to premorbid residence
Majority will have some residual pain or disability

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