hip fracture Flashcards
features of hip fracture
- pain - hip / groin / thigh
- shortened and externally rotated leg
- patients with non-displaced or incomplete neck of femur fractures may be able to weight bear
- hx of fall / trauma
- inability to weight baear or move hip
blood supply of hip
location of hip fracture
intracapsular (subcapital):
* from the edge of the femoral head to the insertion of the capsule of the hip joint
extracapsular:
* these can either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line)
classification system for hip fracture
garden system
garden system for intercapsular hip fractures
Type I: Stable fracture with impaction in valgus
Type II: Complete fracture but undisplaced
Type III: Displaced fracture, usually rotated and angulated, but still has boney contact
Type IV: Complete boney disruption
Blood supply disruption is most common following Types III and IV.
mx of undisplaced intracapsular hip fracture
internal fixation,
or hemiarthroplasty if unfit.
mx of displaced intracapsular hip fracture
- total / hemi arthroplasty (hip replacement)
total if
* used no more than a stick
* not cognitively impaired
* medically fit for anaesthesia
mx of extracapsular hip fracture
- stable intertrochanteric fractures: dynamic hip screw
- if reverse oblique, transverse or subtrochanteric fractures: intramedullary device
dynamic hip screw
intermedullary device
why are intracapsular fractures ‘worse’
The retinacular vessels that pass up the femoral capsule may be damaged, especially if the fracture is displaced,
-> resulting in poor blood supply to the femoral head
-> avascular necrosis.
RF for hip fracture
- fall
- osteoporosis/osteopenia
- malignancy - pathological fractures
- female
- high energy trauma
- medication
- alcohol - increase risk of falls and osteoporosis
ix for hip fracture
XR - ap and lateral views
FBC, UE
glucose
G&S
coag screen
ECG
