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44 Cards in this Set

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