Neck of Femur Fracture
70 Year Old Female brought into ED after a fall. Confused with an AMTS 5/10.
This is an AP and Lateral plane film radiograph of an unknown skeletally mature individual’s pelvis and right hip. There are no patient identifiers and the radiograph is undated. The most obvious abnormality is that there is a: discontinuity of Shenton’s line with a completely displaced right sided intracapsular fracture. There is shortening of the distal fragment. There are no other fractures. The fracture would be classified according to the Garden’s Classification as a Gardens type 4 fracture.
I would manage this patient according to ATLS principles (Silver Trauma).
I would complete a full primary survey to rule out life threatening injury. I would then assess the limb in question as part of the secondary survey.
I would assess the neurovascular status of the limb (sciatic nerve function, cap refill, distal pulses).
I would manage the patient using a local NOF proforma, NICE guidelines, BOAST guidelines and Best practice tariffs.
The patient should have a full set of trauma bloods, CXR, ECG and anaesthetic review. They should also have appropriate analgesia. A fascia iliaca block should also be performed.
BOAST 1 guidelines
Nottingham Hip Score
- Age 66-85, >86
- HB <10
- AMTS <8
- Living in an institution
- More than 1 co-morbidity
- Acute malignancy within the last 20 years
The blood supply to the femoral head is mostly retrograde:
- Main supply is via an anastomosis of the lateral and medial circumflex femoral artery and superior gluteal artery
- Small nutrient artery which is intramedullary
- Small supply via artery of the ligamentum teres (obturator artery)
Ligaments: iliofemoral ligament, pubofemoral and ischiofemoral
Anterior attachment – Intertrochanteric line
This patient has a AMTS of 5/10 and a completely displaced NOF fracture. They would qualify for a Hemiarthroplasty as per NICE guidelines.
In an appropriately marked, consented WHO checklisted patient