Hip fracture Flashcards
How common is a #NOF?
A very common orthopaedic presentation
> 65,000/year in the UK
What is the mortality of #NOF at 1 year?
30%
What can be done to combat the high mortality from a #NOF?
Specialist care
Orthogeriatricians on orthopaedic wards
What are #NOF typically caused by?
Low energy injuries (e.g., fall in a frail elderly patient)
High energy injuries (e.g., RTA, fall from height) - often associated with other significant injuries
What are the two distinct areas of the NOF?
Intra-capsular = from subcapital region of femoral head to basocervical region of femoral neck (immediately proximal to the trochanters)
Extra-capsular - outside the capsules. Subdivided into:
1. inter-trochanteric - between greater and lesser trochanter
2. sub-trochanteric - from lesser trochanter to 5cm distal to this point
What is the blood supply to the NOF?
Retrograde - from distal to proximal along the femoral neck to the femoral head
Mainly through the medial circumflex femoral artery (lies directly on the intra-capsular femoral neck)
What is the danger of displaced intra-capsular fractures?
Disruption of blood supply to femoral head → avascular necrosis
What’s the best way to manage a patient with a displaced intra-capsular fracture?
Joint replacement
How can intracapsular fractures be further classified?
Garden Classification
Non displaced classes
I = incomplete
II = complete fracture but nondisplaced
Displaced classes
III = complete fracture, partial displacement
IV = complete fracture fully displaced
What are the main symptoms of a #NOF?
Trauma → pain (felt mainly in groin, thigh, or referred to the knee which is common in the elderly)
Inability to weight bear
What are some examination findings you might see in a #NOF?
Shortened leg
Externally rotated
Pain on pin-rolling the leg
Axial loading
Full neurovascular exam is essential
N.B. - important to investigate cause of the fall (especially if there is not a clear Hx of a trip or a slip)
What are potential differentials?
Alternative fractures (e.g., pelvis esp pubic ramus, acetabulum, femoral head, femoral diaphysis)
Pathological fracture - consider if there is no significant Hx of trauma
What investigations should be done?
Bloods - baseline (FBCs, U&E, coagulation screen, group and save, CK if long lie to assess for rhabdo)
Imaging - plain-film radiographic imaging
Urine dip, CXR and ECG useful in complete assessment of the elderly
What should the plain-film radiographic imaging include?
AP and lateral views of affect hip
AP pelvis (useful for assessing contralateral normal hip for pre-operative planning and templating)
How would you management a patient with #NOF initially?
A to E - to stabilise patient + treat any immediately life-threatening or limb threatening problems
Give adequate analgesia (i.e., opioid analgesia and/or regional anaesthesia e.g., fascia-iliaca block)
