Hip Fractures

Question 1

What strengthens the neck of femur?

Answer 1

Calcar femorale

Question 2

Displacement of hip fractures is due to:

Answer 2

1) Energy of trauma
2) Gravity
3) Muscle action on the separated segment

Question 3

Why is the injury to the femoral neck risky?

Answer 3

1) End arteries
2) No anastamosis

Question 4

Which arteries form an anastomotic ring around the intertrochanteric area?

Answer 4

1) Medial circumflex femoral artery
2) Lateral circumflex femoral artery

Question 5

What’re the 3 groups of the arteries of the proximal end of the femur?

Answer 5

1) An extracapsular arterial ring located at the base of the femoral neck
2) Ascending cervical branches of the extracapsular arterial ring on the surface of the femoral neck (end arteries)
3) Arteries of the ligamentum teres (branch of the obturator)

Question 6

Mechanism of hip fractures in old patients?

Answer 6

Low energy trauma in osteoporotic bones

Question 7

Mechanism of hip fractures in young patients?

Answer 7

High energy trauma

Question 8

How does a patient with a displaced hip fracture present?

Answer 8

Cannot stand or ambulate

Question 9

How does a patient with a non-displaced/impacted hip fracture present?

Answer 9

May be ambulatory with minimal pain

Question 10

Describe the extremity of a patient with a displaced proximal femur fracture.

Answer 10

1) Shortened
2) Externally rotated
3) Ecchymosis

Question 11

A patient with a displaced proximal femur fracture will be tender to palpation where?

Answer 11

Greater trochanter

Question 12

Should we do range-of-motion testing of the hip in hip fractures?

Answer 12

No; it’s painful

Question 13

A patient presents with thigh/groin pain without any history of trauma. What should you suspect?

Answer 13

1) Stress fracture of the proximal femur
2) Pathological causes (no trauma)

Question 14

What is the difference between fatigue and insufficiency fractures?

Answer 14

• Fatigue: Abnormal stress on normal bone
• Insufficiency: Normal stress on abnormal bone

Question 15

How are femur fractures classified?

Answer 15

Based on area/location of the fracture

Question 16

Proximal femur fractures are divided into groups based on their location with regard to:

Answer 16

The capsule:
1) Intracapsular
2) Extracapsular

Question 17

Intracapsular fractures are associated with injury to:

Answer 17

The blood supply to the head of the femur = Avascular necrosis of the femoral head

Question 18

Femoral neck fractures are classified as;

Answer 18

1) Subcapital fractures
2) Transcervical fractures
3) Basicervical fractures

Question 19

Which femoral neck fracture is the worst?

Answer 19

Subcapital fracture

Question 20

Which femoral neck fracture has the highest risk of malunion?

Answer 20

Basicervical

Question 21

Which femoral neck fracture has the lowest risk of malunion?

Answer 21

Subcapital

Question 22

Which femoral neck fracture has the lowest risk of AVN?

Answer 22

Basicervical

Question 23

Extracapsular fractures are separated into:

Answer 23

1) Intertrochanteric
2) Subtrochanteric

Question 24

Which intertrochanteric fracture is the worst according to Evan’s classification?

Answer 24

Reversed oblique

Question 25

When do you fix a femur neck fracture?

Answer 25

When the patient is young (<65)

Question 26

When do you replace a femur neck fracture?

Answer 26

When the patient is old (>65)

Question 27

What is the aim for inter/subtrochanteric fractures?

Answer 27

Restore:
1) Length
2) Alignment
3) Rotation

Question 28

Do we do anatomical reduction for inter/subtrochanteric fractures?

Answer 28

NO

Question 29

What are the local complications of femur fractures?

Answer 29

1) AVN
2) Non/Malunion
3) Failure of fixation
4) Posttraumatic arthrosis

Question 30

What are the general complications of femur fractures?

Answer 30

1) DVT
2) PE
3) Pneumonia
4) Bed sores