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44 Cards in this Set
- Front
- Back
risk factors associated with increased risk of sustaining a hip fracture
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BMI <18.5
low sunlight exposure low recreational activity smoking h/o previous osteoporotic fracture maternal h/o hip fracture corticosteroid treatment |
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mechanisms of injury
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fall
external rotation of leg high energy trauma stress fracture |
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associated injuries
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(vast majority are isolated)
distal radius proximal humerus ipsilateral femoral shaft |
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femoral neck fracture incidence with a femoral shaft fracture
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2-6%
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physical presentation of displaced femoral neck
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shortened
externally rotated |
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traction?
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no conclusive benefits in:
pain relief ease of fracture reduction quality of reduction |
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laboratory eval and tests
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CBC with diff
type and screen BMP EKG (>60 or heart hx) |
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Garden classification based on
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AP view, relationships of trabecular lines in femoral head to acetabulum
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Garden classification
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I: valgus impacted and retroverted, can be incomplete
II: complete, nondisplaced (no shift in alignment) III: marked varus angulation, no proximal translation of shaft IV: complete displacement with shaft shifted proximally (trabecular lines of fem head and acetab realign) |
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Pauwell classification based on
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plane of fracture (transverse, oblique, vertical)
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Pauwell classification
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I: transverse (<30 deg)
II: oblique (30-50 deg) III: vertical (>50 deg) - younger patients |
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femoral neck angle
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neck angle with femoral shaft
normal 130-135 |
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femoral anteversion
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angle between femoral neck and transcondylar axis
normal 15-25 |
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hip axis length
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distance from lateral aspect of trochanteric region along femoral neck to inner table of the pelvis
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measurements associated with increased risk of femoral neck fracture
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increased hip axis length
femoral neck width lower neck shaft angle |
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calcar femorale
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dense vertical plate of bone extending from posteromedial portion of femoral shaft under the lesser trocheter radiation to greater troch and reinforcing posteromedial portion of the femoral neck
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most important source of femoral head blood supply
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capsular vessels
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origin of capsular vessels
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femoral a --> profunda femoris a --> medial/lateral circumflex femoral a --> ascending cervical capsular vessels
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retinacular vessels
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ascending cervical capsular vessels within the capsule
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most important retinacular vessels
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deep branch of medial femoral circumflex a
(supply main weight-bearing area of femoral head) penetrate femoral head 2-4 mm proximal to articular suface on posterosuperior aspect |
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four groups of retinacular vessels
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anterior
medial lateral (largest contributor to femoral head) posterior |
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subsynovial intraarticular ring
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second ring anastomosis at junction of articular surgace of femoral head and femoral neck
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sources of femoral head blood supply
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capsular vessels
intramedullary vessels contribution from ligamentum teres |
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artery of ligamentum teres arises from
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obturator or medial femoral circumflex a
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why see prolonged union times in femoral neck fractures
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no cambial layer so must heal by endosteal mechanism alone (no callus forms)
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extent of hip joint capsule
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extends down to intertrochanteric line over anterior aspect of the femoral neck
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3 ligamentous stabilizers of the hip
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ischiofemoral
iliofemoral pubofemoral |
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ischiofemoral ligament
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controls internal rotation in flexion and extension
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lateral arm of iiofemoral ligament
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external rotation in flexion
internal and external rotation in extension |
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pubofemoral ligament
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controls external rotation in extension
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sources of sensation to hip joint
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obturator
femoral sciatic superior gluteal |
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anteromedial part of hip joint innervation
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obturator
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anterior capsule innervation
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femoral n
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posterior aspect of joint innervation
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sciatic n
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posterolateral capsule innervation
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superior gluteal n
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hip flexors
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iliopsoas
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insertion of iliopsoas
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lesser trochanter
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hip external rotators
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piriformis
gemelli obturator internus |
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hip abductors
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gluteal muscles (superior gluteal n)
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hip adductors
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adductor longus
adductor magnus adductor brevis (all by obturator n) |
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Y ligament of Bigelow
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iliofemoral ligament
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capsule attachments
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anteriorly to intertrochanteric line
posteriorly 1-1.5 cm proximal to intertrochanteric line |
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path of medial femoral circumflex
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between pectineus and psoas
passes posterior under quadratus |
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path of lateral femoral circumflex
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passes deep to sartorius and rectus
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