0:00 Neck of femur fractures cause significant morbidity and are associated with 0:13 increased 0:14 mortality. 0:16 Neck of femur fractures, or hip fractures, are used interchangeably and are 0:21 used to denote 0:22 a fracture in the proximal femur. 0:25 Neck of femur fractures are the most common fracture in the elderly, with an 0:29 exponential 0:30 increase in incidence with age. 0:33 Most hip fractures are associated with a fall, although other risk factors, 0:37 including decreased 0:38 bone mineral density osteoporosis, reduced level of activity and chronic 0:43 medication use. 0:46 Fractures in the young are usually a result of high-energy trauma. 0:50 Neck of femur fractures in this video may be referred to as "nough", a term 0:55 used by 0:56 healthcare workers. 0:59 Let's first talk about classification. 1:06 Neck of femur fractures should be described anatomically. 1:09 They are divided into either intra-capsular fractures and extra-capsular 1:16 fractures. 1:17 The capsule in this sense is a strong fibrous material, lined internally by the 1:23 synovial 1:24 membrane. 1:26 The fibrous layer on the outside of the capsule is attached to the acetabulum 1:32 proximally, 1:33 and distally it attaches to the inter-trochanteric line anteriorly. 1:44 And therefore we have intra-capsular fractures, which occur within the joint 1:50 capsule proximal 1:51 to the inter-trochanteric line. 1:55 These could be further divided into femoral head fractures or femoral neck 2:00 fractures, 2:01 which are divided into then sub-capital, trans-survival and base-survival. 2:13 Extra-capsular fractures occur distal to the joint capsule and are divided into 2:18 either 2:19 inter-trochanteric or sub-trochanteric below the lesser trochanter. 2:30 It is then important to describe the factors as being displaced or undisplaced, 2:36 as blood 2:36 supply may be affected. 2:38 The relationship to the blood supply is very important. 2:42 You see, the femoral head receives its supply via the medial and lateral fem 2:46 oral circumflex 2:47 arteries, which form the extra-capsular ring and give rise to the cervical 2:53 arteries, the 2:54 lateral being most important. 2:57 There is also supply via the intra-osseous nutrient vessels and the ligamentum 3:07 terrace. 3:07 Both intra-capsular fractures disrupt their blood supply and have a high rate 3:13 of A-vascular 3:14 necrosis, which is basically bone death, of the femoral head, as well as what's 3:21 called 3:22 non-union, when the bones don't join up together eventually. 3:28 On the other hand, extra-capsular fractures maintain the blood supply to the 3:33 head, thus 3:34 reduced risk of a-vascular necrosis, and these fractures normally heal well. 3:46 Some risk factors for nekofema fractures, include the non-modifiable risk 3:51 factors, age greater 3:53 than 65 for having a family history of fractures, female sex, low socioeconomic 3:59 status, and 4:00 prior hip fractures. 4:02 Modifiable risk factors include the medications that the person uses, such as 4:07 thyroxine, bruzomide, 4:09 proton pump inhibitors, and sedatives, because they increase the risk of falls. 4:14 Other modifiable risk factors include osteoporosis, falls risk, reduced level 4:19 of activity, and 4:20 vitamin D deficiency. 4:27 The clinical presentation is really inability to weight bear following a fall 4:32 on the affected 4:33 side. 4:34 In the elderly, this is a very common presentation and presents with 4:38 significant pain. 4:40 It's important to consider other medical causes of the fall, such as a heart 4:44 attack 4:44 or a stroke, and it's also important to look for other injuries, such as knee 4:51 problems, 4:52 neck problems, or shoulder problems. 4:56 Pain may be referred to the distal femur, or upper knee. 5:00 Non-displaced nekofema fractures can firstly appear normal. 5:09 Displaced nekofema fracture, on the other hand, the leg will be shortened 5:13 externally 5:14 rotated with abduction. 5:17 Muscle spasm contributes to the shortening of limb, whereas if you have a 5:22 posterior dislocation 5:24 of the femur, without a fracture, you will have shortened leg, internal 5:30 rotation, and 5:32 adduction, adduction. 5:35 Straight leg raise and hip movements are globally inhibited by pain. 5:40 Neurological state is important to assess. 5:48 Investigation and diagnosis, NOF is a clinical diagnosis. 5:52 Exray is important to gain further information to classify the fracture. 5:56 Here is a normal x-ray, and here is a fracture of the left neck of femur. 6:02 It is a sub-capital fracture. 6:07 Undisplaced fracture is difficult to see on x-ray, and so sometimes bone scan 6:13 CT or MRI, 6:14 which is gold standard, is used. 6:16 It's also important to look at blood tests, specifically screening for osteopor 6:20 osis, such 6:20 as vitamin D and calcium. 6:28 Treatment of fractures is very important. 6:31 Early surgery within 24 to 48 hours is prudent. 6:35 This allows early mobilization and rehabilitation, which speeds functional 6:40 recovery and decreases 6:42 the risk of other problems such as pneumonia, skin breakdown, deep vein thromb 6:47 osis and 6:47 urinary tract infections. 6:50 Persons with comobilities, however, have an increased risk of mortality, 6:54 therefore surgery 6:55 may need to be delayed. 6:59 Prior to surgery, appropriate analgesia is important. 7:04 This is usually with a combination of a femoral nerve block and short-acting 7:09 opioids. 7:10 Whilst on opioids, it's important to check bowel motions. 7:19 For intracapsular neck of femur fractures, if they're undisplaced intracapsular 7:25 fractures, 7:27 you treat by early mobilization with analgesia, but obviously surgery is done 7:32 by internal 7:33 fixation with either cannulated screws or dynamic hip screws. 7:42 Displaced intracapsular fractures are treated by hemiparthroplasty. 7:47 Also hip arthroplasty can be used if symptomatic preexisting arthritis is 7:54 present or with those 7:56 who have a few comobilities and are actually high functioning. 8:01 In children or young adults with intracapsular neck of femur fractures, 8:05 reduction either 8:06 open or closed and fixation is employed. 8:14 For capsule neck of femur fractures, if they're inter-trochanteric fractures, 8:19 usually a sliding 8:21 or dynamic hip screws are used and a plate system, following a closed reduction 8:25 on a 8:25 traction table. 8:28 Sub-trochanteric fractures are a four-part inter-trochanteric fracture, which 8:32 is complex. 8:33 This is managed with an intra-modillary nail. 8:43 These of neck of femur fractures include many things. 8:46 Firstly, death, especially due to increased mortality in the elderly, a 8:51 vascular necrosis 8:52 of the femoral head, as mentioned, specifically in a intracapsular-displaced 8:57 fracture, a dislocation 8:58 of the hip surgery, the arthroplasty, loss of fixation, nonunion, and malunion, 9:07 lower 9:07 limb thromboembolic disease as well. 9:15 So in summary, femoral neck fractures are very common in the elderly and is 9:20 usually a result 9:21 of fall in the setting of osteoporosis. 9:25 Neck of femur fractures can be classified into intracapsular fractures or ext 9:29 racapsular 9:29 fractures. 9:31 Early surgery is important to allow early mobilization and prevent displacement 9:36 .
