Hip Fractures Flashcards Preview

MSK - my cards > Hip Fractures > Flashcards

Flashcards in Hip Fractures Deck (43):
1

Explain increased incidence of hip fractures in Scottish population:

Increased ageing population

2

Who is MOST likely to suffer a hip fracture?

Over 80 yo
Female (around 75% of hip # female)

3

What is the lifetime risk of hip fracture for males and females for >50s?

Male 5-10%
Female 15-20%

4

Cost of treatment per patient per year?

>£12500 per patient per year
(>£73 million per year in Scotland alone)

5

When patient falls, causing hip fracture, what could be the cause?

Cerebrovasuclar disease
Cardiac arrhythmia
Potural hyotension
Mechanical Fall
(usually no obvious organic cause falls)

6

What condition of the bones makes a hip fracture more likely?

Osteoporosis
(age related, qualitative defect of bone, more common in females, may be related to smoking, alcohol or steroids)

7

What are the risks of motality after a hip fracture after 1 month, 3 months and 1 year?

1 month - 10%
3 months - 20%
1 year - 30%

8

How are vast majority treated?

Surgery

9

What are risks of not operating on hip fracture?

Prolonged bed rest - risks
Very painful
Surgery gives best chance of patient returning home
Only patients with very severe co-morbidities (expected to die) are not operated on

10

If patient lives independantly, what are the risks of requiring institutional care post-hip #?

20% risk of requiring institutional care
(residential home, nursing home)

11

What surgical complications are associated?

Failure of fixation
AVN (avascular necrosis)
Non-union ( when a broken bone fails to heal)
Infection (5%)
Dislocation

12

Which clinical features suggest a hip fracture?

Limb shortening
External rotation
Trochanteric bruising
Unable to SLR (straight leg raise)
Severe groin pain or rotational movements

13

What two muscles are attached (laterally) to the hip? (gluteus..)

Gluteus medius (larger)
Gluteus minimus

14

What muscle attaches the femur to the spine?

Illiopsoas psoas (major)

15

What muscle attaches the femur to the ilium?

Illiopsoas illacus

16

What muscle attachments are involved in the hip joint?

Gluteus medius
Gluteus minimus

Illiopsoas psoas major (minor attached)
Illipsoas iliacus

Adductor magnus
Adductor brevis
Adductor longus
Gracilis (attaches to medial surface of tibia)

Pectineus

Sartorius

17

Which (branch of which) artery is the main blood supply to head of femur?

Branch from obturator artery ( which is a branch of internal iliac artery)

18

Which branch of the circumflex arteries gives off the retinacular arteries?

Medial

(medial and lateral circumflex arteries --> medial branch gives off retinacular arties --> retinacular arteries supply hip joint)

19

Which arteries supply most of the blood supply to the hip joint?

Retinacular arteries
(given off from medial circumflex branch)

20

What is the other name for zona obicularis?

Annular ligament

21

Which ligments are in the hip capsule?
(4)

Illiofemoral ligament (anterior and posterior)
Pubofemoral ligament (anterior)
Ischiofemoral ligament (posterior)
Zone obicularis (annular ligament) (posterior)

22

What is the 5cm area inferior to the transtrocharteric area classified as?

Subtrocharteric area

23

What area is the neck of he femur classified as?

Intracapsular

24

What is the area between the intracapsular area and the subtrochanteric area classified as?

Extracapsular

25

How do you investigate hip fracture?

X-ray
MRI for occult fractures

26

Why is it so important to get hip operation right the first time?

Elderly patients may not survive second operation and functionally deteriorate

27

Which gives better function, a total replacement or a hemiarthroplasty?

Total Hip Replacement

(THR gives higher function than hemiarthroplasty but there is a higher dislocation rate)

28

When would you do hemiarthroplasty instead of total replacement?

In those with poorer function or cognitive defect.

(hemiarthroplasty just replaces head of femur, only half of the hip joint is replaced, not the whole joint)

29

When may you consider FIXATION (rather than replacement)?

In undisplaced fractures and intracapsular fractures if younger and fitter patient (<60)

30

What type of surgery is most reliable for intracapsular fractures?

Replacement

31

Do extracapsular fractures pose a risk of AVN?

no

32

What usually causes healing of extracapsular fractures?

Sliding hip screw (dynamic hip screw (DHS))

Can also fix with intramedullary nail and sliing hip screw (less lever arm)

33

What does success of fixation of extracapsular fractures depend on?

Quality of reduction and centrality of screws in head
(also, uncreased number of parts --> increased instability and increased failure rates)

34

In a subtrochanteric fracture, what gives a higher risk of non-union?

If the blood suppl to the fracture site isn't as good

35

Long-term use of which type of drugs has been linked to incidence of subtrochanteric fractures?

Bisphosphonate use

(used to slow down or prevent bone damage)

36

Why is an intramedullary nail (IM nail) superior?

May last longer before breakage if delayed union

37

How is a pubic rami fracture different from high energy pelvic fracture?

N major displacement and bleeding in pubic rami fracture

38

What are the symptoms of a pubic rami fracture?

Tender groin
(less pain on rotation than hip #)

39

Management of greater trochanter fracture?

Usually conservative management
Can get MRI --> to see if fracture traverses femoral neck --> if so --> internal fixation

40

Prevention of future hip fractures:

Exercise may help maintain muscle strength and bone mineral density.

(Falls clinic, anti-resoptive drigs for osteoporosis, hip protectors may be used -> ALL NO PROVEN BENEFIT)

41

How may you treat Intracepsular fracture in younger patient?

Fixation

42

How may you treat Intracepsular fracture if undisplaced?

Fixation

43

How do you fix extracapsular fracture?

Dynamic Hip Screw (DHS)