Neck of Femur Fractures Flashcards
(38 cards)
What are the two types of NoF fractures?
Intracapsular and extracapsular
What is the standard patient for NoF fracture?
Caucasian woman in her 7th/8th decade
What is the usual underlying pathophysiology in low trauma NoF fracture
Osteoporosis
Give three types of intracapsular fracture
Subcapital
Transcervical
Basiccervical
Give two types of extracapsular fracture
Intertrochanteric
Subtrochanteric
Give four clinical features of NoF fracture
Shortened limb
Externally rotated
Painful, tender hip
Failed leg raise
What are the two main questions to ask when looking at a NoF radiograph?
Is there a fracture?
Is it displaced?
What are you looking for in fracture?
Breaks in cortices
Length of spread
What are two clues that a fracture is displaced?
Disruption of shentons line
Mismatch between trabecular lines of femoral head and the supra-acetabilar part of the pelvis
Why is displacement an importnat thing to diagnose?
Undisplaced or impacted fracture do better, displaced do worse
What is Shenton’s line?
Line along lesser trochanter, femoral neck and inferior superior pubic ramus
What is Gardners classification used for?
Classifying intracapsular fractures of the hip
Give the four stages of GArdner classifcation
Stage I – Incomplete impacted fracture with femoral head tilted into slight valgus
Stage II – Complete but undisplaced fracture
Stage III – Complete fracture with moderate displacement
Stage IV – Severely displaced fracture
Which gardners have the best prognosis?
I and II as less displaced
What is the difference between III and IV
III usually does not have alignment of trabecular lines of the femoral head with the supra-acetabular trabecula. IV usually does, as proximal fragment completely displaced from neck of femur and rests in neutral position.
Give four NoF fractures not to miss
1) Stress fractures – High index of suspicion of NoF for elderly patients with hip pain and young patients with pain who do regular impact loading sports
2) Undisplaced fractures – Very subtle fracture line can lead to it being missed
3) Painless fractures – bed ridden patients may fracture their hip and lead to impaction
4) Multiple fractures – Patient with a femoral shaft facture may also have a NoF fracture
Give some investigations for NoF fracture
- AP and lateral radiograph
- FBC and cross-match
- Renal function, glucose, ECG, CXR
What is the initial management for NoFF?
Initial management is splinting and pain relief, with compartment block (femoral, obturator and lateral cutaneous nerve) if surgery is going to be delayed.
How do you treat a displaced intracapsular NOFF?
- Hemiarthroplasty in unfit patients, THR in fit patients
When would you use THR for dis intra NOFF
THR sometimes used in younger patients, delayed treatment with acetabular damage or patients with metastatic or pagets disease.
How would you treat undisplaced intracapsular fracture?
o Fracture is reduced internally to start
Patient under anaesthesia the fracture is disimpacted by applying traction with the hip held in 45* of flexion and slight abduction, the limb is then slowly brought into extension and finally internally rotated. As traction is released the fracture reimpacts in the reduced position.
Open reduction can also be tried in stage III and IV fractures in patients
What is important to do post-op?
- Breathing exercises
- Early mobilization
What is the prognosis for NoFF?
One in ten patients die within thirty days, one in five within one year. High risk of post-operative complications.
What are the three sources of blood of the femoral head?
1) Ascending cervical branches of the medical circumflex and lateral cicumflex arteries which arise from femoris profundus and run within the capsular retinaculum before entering bone at the articular margin of the femoral head
2) The intramedullary vessels of the femoral neck
3) The vessels of ligamentum teres
