Hip Fractures Flashcards
What is a hip fracture?
A fracture in the upper 1/4 of the femur.
-within 5cm of distal lesser trochanter
How are hip fractures classified? (5)
By location:
- Subcapital
- Transcervical
- Basicervical
- Intertrochanteric
- Subtrochanteric
What are intracapsular fractures?
Fractures between the femoral neck and intertrochanteric line.
-Subcapital, transcervical & basicervical
What is the main blood supply to the femoral head?
Trochanteric anastomoses.
-nutrient arteries beneath capsule
Which arteries join to form the trochanteric anastomosis?
Inf/sup and med/lat femoral circumflex arteries.
A branch from which artery also provides a small contribution to the femoral head?
A branch of the obturator artery.
-runs along ligamentum teres
What can happen to the blood supply of the femoral head if it is fractured/displaced?
Retinacular and nutrient vessels may be torn»_space; avascular necrosis.
Which arteries join to form the retinacular vessels?
Medial and lateral femoral circumflex arteries.
What does the cruciate anastamosis supply?
Trochanteric area and upper femur.
What is the mean age for a hip fracture?
84 years old.
What proportion of hip fractures are in over 65s?
87%.
Are hip fractures more common in men or women?
3x more likely in females.
What are the main causes of hip fractures? (2)
- Simple fall (» fragility fracture)
- Rotational force on hip (without trauma)
What are the main risk factors of hip fractures?
AGING
»Osteoporosis
»Falls
If due to low impact trauma, what normally leads to hip fracture?
Underlying bone condition.
What underlying bone condition may lead to hip fractures? (5)
- OSTEOPOROSIS (most common)
- OSTEOMALACIA (vit. D deficiency)
- BONE METASTASES
- HAEMATOLOGICAL MALIGNANCY
- PAGET’S DISEASE
How do hip fractures commonly present?
- Fall
- Pain (groin/thigh/knee)
- Difficulty weight bearing
- Deformity
What are common deformities if hip fractures are displaced? (2)
- Shortened limb
- Externally rotated
What is the main nerve supply to the hip?
Anterior division of the obturator nerve.
Why is there often referred pain to the knee?
Posterior division of the obturator nerve supplies the knee.
What do previous fractures suggest?
Osteoporosis.
What are possible causes of falls?
- Acute medical illness
- Cardiac related
- Medication/alcohol related
- Cognitive impairment
How do undisplaced legs present?
Look normal, but especially painful on internal and external rotation.
What is rhabdomyolysis?
The destruction of striated muscle cells.
