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Flashcards in Lower Limb Deck (14):
1

What are the three types of hip fracture?

1. Femoral neck (subcapital) - intracapsular

2. Intertrochanteric - extracapsular fracture including the greater and lesser trochanters and transitional bone between the neck and shaft

3. Subtrochanteric - fracture begins or below the lesser trochanter and involves the proximal femoral shaft

2

Describe the Garden classification of femoral neck fractures,

Type I - undisplaced incomplete/valgus impacted
Type II - undisplaced complete (across the whole neck)
Type III - complete fracture, incompletely displaced
Type IV - complete fracture, totally displaced

3

How is an extracapsular femoral fracture fixed?

Intertrochanteric: DHS Subtrochanteric: intramedullary nail

4

What is Shenton's line and what is its significance?

Formed by the medial edge of the femoral neck and the inferior edge of the superior pubic ramus

Loss of contour of Shenton's line is a sign of a NOF #

But fractures of the femoral neck do not always cause loss of Shenton's line

5

What thromboprophylaxis is used post-surgery?

enoxaparin + TEDS

SC 40mg

6

How is a Type I NOF fixed?

Internal fixation to prevent displacement

7

How is a Type II NOF fixed?

Internal fixation to prevent displacement

8

How is a Type III NOF fixed?

Elderly: hemi-/total hip arthroplasty
Young: ORIF

9

How is a Type IV NOF fixed?

Elderly: hemi-/total hip arthroplasty
Young: ORIF

10

Describe the blood supply of the femoral head.

Distal to proximal blood supply along femoral neck to head (medial and lateral femoral circumflex arteries)

Susceptible to AVN if blood supply disrupted

11

Which movements are lost first in hip arthritis?

Internal rotation and abduction

12

What bloods would you order in a patient with a hip fracture?

FBE - Hb, platelets
Coagulation profile
UEC
CMP
LFT
Blood cultures/MSU - if clinically indicated
Group and hold

13

How is hip OA managed?

Non-operative:
1. Analgesia
2. Weight loss if appropriate
3. Activity modification (avoid activities that aggravate hip pain)
4. Walking aid
5. Physiotherapy: to condition muscles
6. Inflammatory process: joint steroid injections

Operative:
1. Most common - THR
2. Re-alignment osteotomy
3. Arthrodesis

14

What are the complications of a THR?

General risks: bleeding, infection, anaesthetics

Specific: Nerve injury (sciatic, femoral, obturator), leg length discrepancy, need for revision surgery, dislocation and fracture