T&O - NOF Flashcards Preview

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Flashcards in T&O - NOF Deck (14)
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1
Q

Patterns of fracture breakage - describe these

A
  • Transverse
  • Oblique
  • Spiral
  • Multifragmentary
  • Compression/crush: when cancellous bone is crumped
  • Stress fractures: repeated stresses that cause bone to fatigue
  • Greenstick: in children, bones are softer and more pliable and bend rather than break
  • Avulsion
2
Q

Displacement of fractures - describe these INSERT PICTURE

A
  • Undisplaced
  • Impaction: fragments driven into one another, causing shortening
  • Angulation: one fragment left angulated relative to other, can lead to deformity of limb (described in degrees)
  • Lateral displacement
  • Rotation - note mismatch between widths of the proximal and distal fragments
3
Q

What is the difference between dislocation and subluxation?

A
  • Dislocation: loss of congruity between articulating surfaces of joint (damage to capsule and surrounding soft tissues)
  • Subluxation: partial loss of congruity between two joint surfaces
4
Q

NOF: demographics and normal findings

A
  • Mainly in elderly females with osteoporotic bone
    • Have high mortality (20-40% in first year)
  • Normal finding
    • Leg externally rotated and shortened (iliopsoas attaches to lesser trochanter of femur and pulls in that direction)
    • All movements painful + can’t weight bear
5
Q

NOF: important clerking points for assessment

A

Premorbid mobility mini mental test score premorbid independence comorbidities

6
Q

NOF: describe the blood supply to the femur

A
  • Mainly from medial and lateral femoral circumflex branches (travel under capsule along neck)
  • Intramedullary vessels
  • Small contribution from Ligamentum teres artery.
7
Q

Where can you get fractures on the NOF? Where does the capsule attach?

A

Capsule attaches to intertrochanteric line anteriorly and intertrochanteric crest posteriorly

9
Q

Describe the garden classification for NOF fractures

A
10
Q

Intracapsular fractures: - which fractures are intracapsular

Rx based on displaced vs undisplaced

A

Subcapital or Transcervical: grouped into Garden classification I-IV

  • Undisplaced: often impacted and would unite alone but usually fixed with screws
  • Displaced: need reduction b/c disrupted blood supply often fixed with either hemi or half hip replacement (elderly)
    • *young pts: consider long term outcome and try internal fixation with screws, if they develop AVN, could be considered for total hip replacement at later
11
Q

What are the rules of thumb for treatment of NOFs (Options being: leave, fix and replace)

A

Intracapsular

Garden 1-2: ORIF with cannulated screws

Garden 3-4:

  • <55: canulated screws (can do full replacement if get AVN- more fit so will survive two GAs + want the limb to last longer)
  • 55-75: total hip replacement if good/fit pt
  • >75: hemiarthroplasty

Extracapsular

Old/unfit patient: ORIF with DHS

Young/fit patient: ORIF with DHS

12
Q

Run through protocol of Initial Mx for a pt with NOF fracture

A
  • Admit pt and assess using ABCDE approach
  • Treat life threatening emergencies/bleeds first
  • Good Hx and social status
  • Cannula + bloods (U&E, FBC and G&S)
  • Get ECG, CXR and pelvis XR + affected limb
  • Mark affected limb for theatre
  • Surgeon obtain informed consent
  • Ensure DVT prophylaxis (TED, foot pumps, LMWH and early mobilisation)
13
Q

What are the main complications of a total hip replacement?

A
  • Dislocation (more likely to dislocate than hemis),
  • DVT
  • Deep infection
  • Nerve damage (sciatic nerve- can lead to foot drop
  • Leg length discrepancy)
  • AVN of femoral head
  • OA
14
Q

What is the prognosis for a pt with NOF?

A
  • 30% mortality in 1 year
  • 50% never regain pre-morbid functioning
  • >10% unable to return to premorbid residence
  • Majority will have residual pain/disability
15
Q

Which fractures are classified as Extracapsular?

A
  • Basicervical
  • Intertrochanteric
  • Subtrochanteric (do not carry same risk of AVN)