Why are almost all hip fractures treated surgically?
Early mobilisation and resoration of function is more likely to be possible and rehabilitation is more likely
How are hip fractures broadly classified?
What is the main blood supply of the femoral head?
(medial and lateral circumflex arteries fromt the profunda femoral artery)
What is the main risk associated with an intracapsular hip fracture?
(blood supply is disrupted)
What are the two main treatment options for an intracapsular hip fracture?
- Total hip replacement
When would a hemiarthroplasty be preferred over a total hip replacement for an intracapsular hip fracture?
- Reduced mobility
- Cognitively impaired
When would a total hip replacement be preferred over a hemiarthroplasty for an intracapsular hip fracture?
- Mobile patient
- No cognitive impairments
(Total hip replacements are more likely to dislocate)
Why is it preferrable to have an extra-capsular hip fracture compared with an intra-capsular hip fracture?
- Blood supply to the femoral head remains intact
- There is a much higher union rate
How can an extra-capsular hip fracture be treated?
Internal fixation (compression or dynamic hip screw)
Subtrochanteric fractures usually occur in which patients?
Elderly osteoporotic patients who fall onto their side
Why do subtrochanteric fractures take a long time to heal?
- There is a relatively poor blood supply
- Non-union occurs frequently
What is the recommended treatment for an intertrochanteric fracture?
(prevents further blood supply disruption)
For patients with a subtrochanteric proximal femoral fracture what can aid with pre-operative pain and fracture stabilisation?
In a patient with no comorbidities, under which circumstances would a femoral shaft fracture occur?
High energy injuries
Stress fractures of the femoral shaft may occur in the presence of which co-morbid conditions?
- Metastatic disease
- Paget's disease
- Long term bisphosphonate use
In terms of femoral shaft fractures, what are two key dangers?
- High blood loss
- Fat from medullary canal can enter the damaged venous system causing a fat embolism resulting in confusion, hypoxia and risk of ARDS
What is the initial management for a femoral shaft fracture?
- Analgesia with femoral nerve block
- Application of Thomas splint
What is the definitive management for a femoral shaft fracture?
Closed reduction and stabilisation with intrameduallary nail
Minimally invasive plate fixation