NOF Fractures

• Likely Population & Contributing Factors

  Avg age = 83 yrs

  75% occurs in women

  Osteoporosis = imp cont factor w women more likely to suffer w osteoporosis than men due to hormonal changes during menopause
• Clinical Features of NOF

  Hx of falls/trauma

  Unable to WB on the affected leg due to increased pain/feeling of instability

  Pain in surrounding hip region

  Affected leg will be usually externally rotated

  Evidence = X-Ray
• Hip Joint Anatomy - Acetabulum

  Situated on the pelvis

  The socket in which the head of femur sits to form the hip joint
• Hip Joint Anatomy - Ball & Socket

  The ball (head of femur) sits in the acetabulum to form the joint

  = allows max movement
• Hip Joint Anatomy - NOF

  NOF = neck of femur

  Prone to fractures due to anatomy & physiology while moving
• NOF Pathophysiology

  Muscles surrounding the joint r likely to be affected during a fall

  = soft tissue injury - bruising, swelling + inflammation

  Will also be affected during surgery cos the cutting of the muscles/moving them to one side to get to the bony region
• Classification Of Fractures - Intracapsular

  Fractures that occur inside the capsule

  = area involved in NOF
• Extracapsular Fractures

  Occurs outside of the capsule

  2 types - Intertrochanteric + subtrochanteric
• Conservative Management - Minor Fractures

  If minor fracture, pt may be walking + managing well w pain being controlled

  Slow gradual process back to baseline + gradual reduction in dosage of pain relief
• Conservative Management - Surgery Risk

  Pt may have an anaesthetic risk where surgical intervention may be too risky

  Pts r likely to be NWB for a considerable amount of time + r likely to spend most of this time supported in bed
• Conservative Management - Surgical Risks

  Risks outweigh the benefits of surgical intervention

  No post-op precautions will be needed
• Types of Surgical Management

  THR - Total Hip Replacement

  Hemi-arthroplasty

  Dynamic hip screw

  Cannulate screws

  Intra-medullary nail
• Factors Affecting Type of Surgery

  Type + location of fracture

  Age

  Level of mobility b4 fracture

  Condition of bones + joints - arthritis/osteoporosis

  Pt's cognition
• Total Hip Replacement

  Removal of the acetabulum (socket)+ femoral head (ball)

  Replaces it w an artificial joint made of a metal alloy/ceramic

  More suited for younger pts

  Pts r able to fully WB

  Higher rate of dislocations = precautions
• Hemi Arthoplasty

  Only removes the femoral head (ball) = half replacement

  Prosthesis = metal stem that fits into the medullary cavity of femur and metal head
• Hemi Arthtoplasty - Prosthesis

  Unipolar - metal stem + head fixed together (most common)

  Bipolar - femoral head swivels attaches to stem

  = designed to reduce the wear + tear of the articular cartilage inside the acetabulum
• Hemi Arthtoplasty - Outcomes

  The acetabulum must be in good condition for this surgery

  Pts r usually able to FWB

  Small risk of dislocation
• Dynamic Hip Screw

  Used in extracapsular proximal fractures, usually intertrochanteric in nature

  Allows controlled dynamic sliding of the femoral head + the hip Joint remains intact

  Shorter surgery - less complicated

  Associated w greater post-op pain

  Usually able to FWB

  No need for precautions
• Cannulated Screws

  Most common I eternal fixation used for non-displaced intracapsular fractures

  2/3 screws inserted to fixate the fracture site

  Hip Joint remains intact

  No precautions needed
• Surgical Complications - Wound Infections

  Check dressing daily, keep covered

  Strict aseptic technique if changing dressings

  Any signs of inflammation/oozing/heat/increased pain must be escalated
• Surgical Complications - Systemic Infections

  Hospital acquired pneumonia (HAP), upper respiratory tract infection (URTI), urinary tract infection (UTI) = common systemic infections

  Keep a close eye on infective markers + monitor chest, any changes must be escalated

  Risk is reduced by using antibiotics at the time of surgery + careful sterile techniques