Hip fractures

Question 1

name 4 differentials for hip pain in adults

Answer 1

• trochanteric bursitis
• osteoarthritis
• referred lumbar spine pain

Question 2

what is referred lumbar spine pain

Answer 2

femoral nerve compression causing referred pain in the hip

Question 3

What is trochanteris bursitis and what causes it?

Answer 3

Due to repeated movement of fibroelastic, the capsule becomes inflamed and causes pain and tenderness over the lateral side of the thigh

Question 4

what age group does trochanteric bursitis typically occur in?

Answer 4

50-70 year olds

Question 5

name 3 causes of avascular necrosis of the femoral head

Answer 5

• hip fracture
• hip dislocation
• high dose steroid therapy

Question 6

what are the features of osteoarthritis of the hip

Answer 6

chronic history of groin ache following exercise and relieved by rest

Question 7

management of osteoarthritis of hip?

Answer 7

• oral analgesia
• intra-articular injections
• total hip replacement is definitive

Question 8

what is the definition of osteoporosis?

Answer 8

Bone mineral density of < 2.5 standard deviations below the young adult mean density

Question 9

How is bone mineral density calculated?

Answer 9

DEXA scan

Question 10

what does a T score of -1.0 mean>

Answer 10

bone mineral density of 1 standard deviation below that of young reference population

Question 11

Management of osteoporosis?

Answer 11

• vitamin D supplements
• Calcium supplements
• Alenronate

Question 12

what is Alendronate?

Answer 12

Bisphosphonate that inhibits the action of osteoclasts

Question 13

how often are alendronate tablets taken?

Answer 13

once daily or once weekly

Question 14

when are alendronate tablets taken? and how?

Answer 14

first thing in the morning when wake up and before eaten or drunk anything (besides water), take with a large glass of water, standing/sitting in an upright position
and
do not eat/drink anything for the following 30 minutes and take separately from taking other medications as they may affect the absorption

Question 15

what are the side effects of alendronate

Answer 15

indigestion, abdo pain, nausea, vomiting, diarrhoea, constipation, headache, dizziness

Question 16

what is the blood supply to the femoral head?

Answer 16

Medial circumflex femoral artery

Question 17

what are the 2 types of hip fractures

Answer 17

intra capsular
and
extra capsular

Question 18

what are the 2 types of intra capsular fractures

Answer 18

displaced and not displaced

Question 19

What does Garden classification 1 + 2 indicate and how should they be managed?

Answer 19

non displacement of the intracapsular hip fracture

managed by fixing e.g. screws

Question 20

What does garden classification 3 + 4 indicate and how should they be managed?

Answer 20

displacement of the intracapsular fracture

managed by hemi-arthroplasty or total arthroplasty

Question 21

how does septic arthritis present?

Answer 21

single, hot, swollen, tender joint

Question 22

joint aspiration should include which investigations when ?diagnosis of septic arthritis

Answer 22

• drain pus
• gram stain
• microscopy
• culture

Question 23

how should a swollen prosthetic joint be managed?

Answer 23

aspirated in theatre

Question 24

what is the likely causative bacteria causing a septic prosthetic joint?

Answer 24

staph or strep

Question 25

what is the abx management of septic arthritis

Answer 25

Flucloxacillin IV 4-6 weeks

Question 26

what abx to give if MRSA is suspected cause of septic arthritis

Answer 26

Vancomycin

Question 27

what bacteria is associated with sickle cell anaemia patients as a cause of osteomyelitis? and what is the management?

Answer 27

salmonella Flucloxacillin/Clindamycin +/- rifampicin IV abx for 6 weeks

Question 28

what is the most common paediatric elbow fracture? and what is the mechanism of injury?

Answer 28

supracondylar fracture fall on hyperextended elbow

Question 29

what is the blood supply to the femoral head?

Answer 29

medial & lateral circumflex arteries

Question 30

what is the 4 types of Gardener classification for intra-capsular fractures?

Answer 30

Type 1 = incomplete, impacted valgus Type 2 = complete fracture - non displaced Type 3 = complete fracture, partially displaced Type 4 = complete fracture, completely displaced

Question 31

hip fracture risk factors

Answer 31

- age - osteoporosis - low muscle mass - steroids - smoking - alochol - mets

Question 32

what is shentons line

Answer 32

the line drawn from the inferior ramus across and down along the inferomedial border of neck of femur - should be smoooth

Question 33

treatment of non displaced intracapsular fractures? (Garden 1/2)

Answer 33

internal fixation with 2/3 screws

Question 34

treatment of displaced intracapsular fractures? (Garden 3/4)

Answer 34

total hip replacement or hemi-arthroplasty

Question 35

who should total hip replacement be offered to?

Answer 35

Displaced intracapsular hip fractures (Garden 3/4) & - able to walk independently out of doors with no more than the use of stick - not cognitively impaired - medically fit for anaesthesia & procedure1

Question 36

where is the location of fracture in intracapsular fractures?

Answer 36

from the edge of the femoral head to the insertion of the capsule @ the hip joint

Question 37

where is the location of fracture in an extracapsular fracture

Answer 37

trochanteric or subtrochanteric

Question 38

management of extracapsular hip fracture?

Answer 38

- DHS (dynamic hip screw) or intramedullary device; if xyz

Question 39

score used to assess function and pain with patients undergoing hip replacement surgery

Answer 39

oxford hip score

Question 40

features of hip OA

Answer 40

chronic history of groin ache followinf exercise and relieved with rest

Question 41

management of Hip OA

Answer 41

- oral analgesia - intra articular injections - total hip replacement is definitive treatment

Question 42

screening tool used to assess the 10 year risk of patient developing a fragility fracture?

Answer 42

FRAX

Question 43

what scan assess actual bone denisty?

Answer 43

DEXA

Question 44

DEXA score of -1.0 to -2.5 is

Answer 44

osteopaeniaa

Question 45

what DEXA score equates to osteoporosis

Answer 45

< -.25

Question 46

mechanism of alendronic acid

Answer 46

inhibits action of osteoclasts

Question 47

how would you explain to a patient how alendronic acid works?

Answer 47

slows down the rate at which bone is being broken down

Question 48

when should you take alendronic acid?

Answer 48

first thing in the morning before eating/drinking anythign, with a large glass of water & continue to stand for following 30 minutes