# NOF
Epidemiology
++ incidence with ++life expectancy
Aetiology
Clinical Features
Investigations
Management
Undisplaced stress #, impacted subcapital # = manage w protected wt bearing but risky
Palliative care sometimes appropriate
Almost always surgery
Preop:
Postop:
Details
Blood supply
Source
Dr Roger Butorac 2014
++ incidence with ++life expectancy
Aetiology
- Overuse injury in younger people
- High energy injury
- Osteoporosis/ osteopenia
Clinical Features
- Inability to stand
- Pain in hip/ groin
- Shortened, externally rotated limb
- Passive mvmt limited by pain
Investigations
- Imaging: Plain XR (diagnostic), CT/MRI, bone scan (take 24h to be +ve)
- Bloods: FBC (baseline), UEC (baseline)
Management
Undisplaced stress #, impacted subcapital # = manage w protected wt bearing but risky
Palliative care sometimes appropriate
Almost always surgery
- Percutaneous screw fixation (minimally invasive)
- Sliding hip screw
- Intramedullary nail
- Hemiarthroplasty (if head necrotic)
- THR (pre-existing arthritis in hip)
Preop:
- ?anticoagulants
- Anaesthetic assessment
- Analgesia, temp stabilisation of #
Postop:
- Anti DVT (stockings, LMWH, aspirin, warfarin)
- Early mobilisation
- Physio rehab
- F/U
- Osteoporosis rx
Details
- Greater trochanter: gluteus medius/ minimus
- Lesser trochanter: iliopsoas
- Gluteal tuberosity: gluteus maximus
Blood supply
- Head of femur: ascending cervical a + subsynovial intracapsular aterial ring + ligamentum teres a
Source
Dr Roger Butorac 2014