Fractured Neck of Femur

Question 1

What is fractured neck of femur (FNOF)?

Answer 1

It is defined as a fracture involving the neck region of the femur bone

Question 2

What are the three classification sytems of fractured neck of femurs?

Answer 2

Anatomical Classification System

Garden Classification System

Pauwels Classification System

Question 3

What is the anatomical classification system of fractured neck of femurs?

Answer 3

It classifies fractured neck of femur according to the location of the fracture within the femoral neck

Question 4

What are the two anatomical classifications of fractured neck of femurs?

Answer 4

Intracapsular Fractured Neck of Femur

Extracapsular Fractured Neck of Femur

Question 5

What is another term for intracapsular fractured neck of femurs?

Answer 5

Subcapital

Question 6

What are intracapsular fractured neck of femurs?

Answer 6

It is defined as a fracture which occurs proximal to the intertrochanteric line

Question 7

What is the pathophysiological consequnce of intracapsular fractured neck of femurs?

Answer 7

It involves damage to the joint capsule, which results in disruption of the blood supply from the femoral circumflex arteries and nutrient arteries

Therefore, there is a high risk of avascular necrosis of the femoral head and non-union of the fracture

Question 8

What is another term for extracapsular fractured neck of femurs?

Answer 8

Intertrochanteric

Question 9

What are extracapsular fractured neck of femurs?

Answer 9

It is defined as a fracture which occurs below the intertrochanteric line

Question 10

What is the pathophysiological consequence of extracapsular fractured neck of femurs?

Answer 10

There is no damage to the joint capsule, and therefore the blood supply to the fracture site is sufficient – leading to improved fracture healing and a good prognosis

Question 11

What is the Garden classification system of fractured neck of femurs?

Answer 11

It classifies fractured neck of femurs according to the degree of displacement visualised on AP radiograph

Question 12

What is garden stage one fractured neck of femur?

Answer 12

It is defined as a stable, incomplete fracture, in which there is impaction in valgus

Question 13

What is garden stage two fractured neck of femur?

Answer 13

It is defined as a complete fracture, which is undisplaced

Question 14

What is garden stage three fractured neck of femur?

Answer 14

It is defined as a complete fracture, in which there is partial displacement – usually rotated and angulated, however still has bony contact

Question 15

What is garden stage four fractured neck of femur?

Answer 15

It is defined as a complete fracture, in which there is complete displacement

Question 16

What is Pauwels classifcation system of fractured neck of femurs?

Answer 16

It classifies fractured neck of femurs according to the angle of the fracture line from horizontal

Question 17

What is Pauwels stage I fractured neck of femur?

Answer 17

It is defined as a fracture angle between 0 and 30 degrees

Question 18

What is Pauwels stage II fractured neck of femur?

Answer 18

It is defined as a fracture angle between 30 and 50 degrees

Question 19

What is Pauwels stage III fractured neck of femur?

Answer 19

It is defined as a fracture angle greater than 50 degrees

Question 20

What are nine risk factors associated with fractured neck of femurs?

Answer 20

Older Age > 65 Years Old

Female Gender

Fragility Fracture History

Falls History

Osteoporosis

Dementia

Visual Impairment

Poor Nutrition

Low BMI < 18.5

Question 21

What are the five clinical features of fractured neck of femurs?

Answer 21

Hip Pain

Weight Bearing Inability

Reduced Hip Movement

Short, Externally Rotated Leg

Positive Log Roll Sign

Question 22

What is a positive log roll sign?

Answer 22

It is stimulation of hip pain on gentle internal and external rotation of the affected leg

Question 23

What two investigations are used to diagnose fractured neck of femurs?

Answer 23

Hip X-Ray

MRI Scans

Question 24

When are hip x-rays used to manage fractured neck of femurs?

Answer 24

They are the first line investigation

Question 25

What are the five features of fractured neck of femur on hip x-rays?

Answer 25

Flexed & Externally Rotated Femur Femoral Neck Smudgy Sclerosis Prominent Lesser Trochanter Angulated Bone Trabeculae Shenton’s Line

Question 26

What is Shenton's line?

Answer 26

It is a loss of contour between normally continuous line from medial edge of femoral neck and inferior edge of the superior pubic ramus

Question 27

What is the gold standard investigation used to diagnose fractured neck of femur?

Answer 27

MRI scans

Question 28

What are the four features of fractured neck of femur on MRI scans?

Answer 28

Flexed & Externally Rotated Femur Femoral Neck Sclerosis Prominent Lesser Trochanter Angulated Bone Trabeculae

Question 29

What is the most appropriate management step in suspected fractured neck of femurs?

Answer 29

We refer for orthogeriatric assessment within 72 hours

Question 30

When is non-surgical management of fractured neck of femurs recommended?

Answer 30

It is used to manage individuals who are unfit for surgical management

Question 31

What are the three non-surgical management options of fractured neck of femurs?

Answer 31

Casts Splints Traction

Question 32

When should surgical management of fractured neck of femurs be conducted?

Answer 32

Within 36 hours of admission

Question 33

What analgesia is recommended in fractured neck of femurs?

Answer 33

Iliofascial nerve block

Question 34

What are the two surgical management options of intracapsular fractures?

Answer 34

Internal Fixation Hip Arthroplasty

Question 35

When is internal fixation used to manage intracapsular fractured neck of femurs?

Answer 35

It is used to manage undisplaced intracapsular fractured neck of femurs in physiologically fit individuals

Question 36

What is internal fixation?

Answer 36

It involves repositioning of the bone fragments, which are then held together with special implants – including dynamic hip screws, cannulated screws or intramedullar devices

Question 37

What two internal fixation implants are used in intracapsular fractured neck of femurs?

Answer 37

Dynamic hip screws Cannulated screws

Question 38

What are dynamic hip screws?

Answer 38

They refer to a flexible plate which is positioned across the fracture line into the femoral head It enables organised collapse of the fractures when the patient weight-bears, which improves fracture healing and union

Question 39

What are cannulated screws?

Answer 39

They refer to a set of plates being driven into the femoral head across the fracture

Question 40

When is hip arthroplasty used to manage intracapsular fractured neck of femurs?

Answer 40

It is used to manage displaced intracapsular fractured neck of femurs OR It is undisplaced intracapsular fractured neck of femurs in physiologically unfit individuals

Question 41

In which three circumstances is total hip arthroplasty used to manage intracapsular fractured neck of femurs?

Answer 41

It is recommended to manage individuals who were able to walk independently with no more than use of stick, who are not cognitively impaired and are medically fit for surgery

Question 42

What is hip arthroplasty?

Answer 42

It involves removal of damaged bone and cartilage and replacement with metal/plastic joint surface in order to restore joint function

Question 43

What is the surgical management option of extracapsular fractured neck of femurs?

Answer 43

Internal Fixation

Question 44

What are the two internal fixation implants used in extracapsular fractured neck of femurs?

Answer 44

Dynamic hip screws Intramedullary devices

Question 45

When are dynamic hip screws used to manage extracapsular fractured neck of femurs?

Answer 45

Stable proximal extracapsular fractures

Question 46

When are intramedullary devices used to manage extracapsular fractured neck of femurs?

Answer 46

Reverse oblique, transverse or subtrochanteric extracapsular fractures

Question 47

What advice should be given to individuals about weight bearing following fractured neck of femur surgery? Why?

Answer 47

All individuals should fully weight bear immediately post-op This is to prevent post-operative complications, including venous thromboembolism, pressure ulcers, bronchopneumonia, etc