NOF FRACTURE caused by what energy injuries?
- low energy ie fall in older pt
- high energy eg road traffic collision
whats more common?
NOF FRACTURE anatomy - where is intracapsular vs extracapsular?
- intracapsular - from below femoral head to before trochanters
- extracapsular:
> inter-trochanteric-between greater and lesser trochanter
>sub-trochanteric-up to 5cm distal to lesser trochanter
https://app.pulsenotes.com/surgery/orthopaedics/notes/hip-fractures
NOF FRACTURE blood supply?
main blood supply to the femoral head is the retrograde via MFCA which comes off of the profunda femoris artery which comes off the deep femoral artery. there is small supply to a small part of the femoral head from the ligamentum teres artery which comes off of the obturator artery.
NOF FRACTURE why do you get avascular necrosis in intracapsular fractures and not in extracapsular?
in displaced intracapsular fractures there is disruption to the MFCA so there is virtually no (ligamentum teres artery is not sufficient) blood supply to the femoral head so there is degeneration. however, in extracapsular fractures the MFCA is not disrupted so the femoral head keeps blood supply (** MCFA wraps around neck and this is where intrascapular fracs occur - this would interrupt artery where as extracapsular are BELOW neck to MCFA not broken and head still gets supply)
NOF FRACTURE garden classification?
Type I - Incomplete, impacted in valgus
Type II - Complete, undisplaced
Type III - Complete, partially displaced
Type IV - Complete, completely displaced
NOF FRACTURE clinical features?
- post low energy trauma pt presents w pain and inability to weight bear
- pain predominantly in groin, thigh or referred to ? commonly in elderly
NOF FRACTURE on examination?
leg is shortened and externally rotated (why?) w pain on pin rolling the leg & axial loading
full neurovascular examination
investigate cause of fall
NOF FRACTURE differential diagnoses?
- alternative fractures eg ??
- pathological fracture if no hx of trauma
NOF FRACTURE investigations?
- hip x ray - AP & lateral views
- pelvis x ray - AP
- suspicion of pathological fracture? full length femoral x ray
- bloods - FBC, U&Es, coag, g&s, creatinine kinase (when and why would you do this?)
- urine dip, cxr & ecg in what age group?
NOF FRACTURE initial management?
- ABCDE
- analgesia - what types?
NOF FRACTURE surgical management?
definitive management is surgical but specific procedures depend on the type of fracture:
- displaced subcapital fracture (intracapsular - occurs at junction between head & neck of femur) - hip hemiarthroplasty
- intertrochanteric (extracapsular between greater & lesser trochanter) & basocervical (extracapsular through base of femoral neck @ its junction w the intertrochanteric region) fractures - dynamic hip screw (or short IM nail)
- non-displaced intracapsular - cannulated hip screws
- subtrochanteric (extracapsular) - anterograde intramedullary femoral nail
EXPLAIN WHAT THESE ARE!!
https://www.physio-pedia.com/Hip_Fracture
NOF FRACTURE immediate post op complications?
- pain
- haemorrhage
- leg length discrepancies
- potential neurovascular damage
NOF FRACTURES long term complications?
- joint disolcation
- aseptic loosening (macrophage-induced inflammatory response that results in bone loss and implant loosening in the absence of an infection)
- peri-prosthetic fracture
- prosthetic joint infection
1/3 mortality at one year
HIP OA what is it?
- degenerative joint disease due to loss of articular cartilage - wear & tear
HIP OA risk factors?
- systemic : inc age, obesity, F, genetic factors, vit d deficiency
- local : hx trauma to hip, anatomical abnormalities, muscle weakness, joint laxity, high impact sports
HIP OA clinical features?
- groin pain aggravated by weight bearing & improved w rest
- stiffness (improves w mobility)
- crunching sensation (creps)
HIP OA OE?
anatalgic gait - may walk w a mobility aid
little to find on palpating
passive movement is painful
severe? reduced ROM
end stage disease? fixed flexion deformity + trendelenburg gait
HIP OA differentials?
- trochanteric bursitis - where does this pain present?
- glut med tendinopathy - where does this pain present?
- sciatica - where does this pain present? what sign is +ve?
- NOF - hx of? how does the limb appear?
HIP OA investigations?
- xray - shows LOSS??
HIP OA initial management?
- analgesia
- lifestyle mods eg x3??
- PT
HIP OA long term management?
- surgery : arthroplasty or hemiarthroplasty
HIP OA surgery comps?
dvt, pe, bleeding, dislocation, infection, prosthesis loosening, leg length discrepancy
HIP OA comps?
revision hip arthroplasty as prosthesis only lasts 15-20 yrs
