Hip fractures Flashcards
(8 cards)
What is the mechanism of injury of Hip fractures?
Mainly fragility fractures due to osteoporosis
What is an intracapsular hip fracture?
In this injury the ball on the top of the femur has broken off at its junction with the neck of the upper thigh bone, within the hip joint.
What is an extracapsular hip fracture?
This break is further down the femur, outside the hip joint and is fixed using metal work.
What is the management of an *undisplaced* intracapsular hip fracture?
- Blood supply is assumed to be uninjured
- Fracture simply needs to be fixed
- This is done by 3 screws
What is the management of a displaced intracapsular hip fracture?
- Blood supply is assumed to be distrupted
- Predisposes the femoral head to vascular necrosis
- Treated by hemiarthroplasty.
- Total hip arthroplasty can be used if symptomatic pre-existing arthritis or those with few comorbidities and high functioning
How is displaced intracapsular hip fracture managed in young patients?
- First line - femoral head is always fixed
What are the 4 principles of fracture treatment?
- Fracture reduction and fixation to restore anatomical relationships.
- Stability by fixation or splintage as the personality of the fracture and the injury dictates.
- Preservation of the blood supply to the soft tissue and bone by careful handling and gentle reduction techniques.
- Early and safe mobilization of the part and patient.
Describe the blood supply to the femoral head?
The femoral head receives its supply via the medial and lateral femoral circumflex arteries
- which form the extracapsular ring and give rise to the cervical arteries (the lateral being most important).
- Displaced intracapsular fractures disrupt their blood supply and have a high rate of avascular necrosis (AVN) of the femoral head and non-union.
- Extracapsular fractures maintain the blood supply to the head (thus reduced AVN and generally heal well).
