Musculoskeletal Trauma Scored and Recorded Self-Assessment Examination 2015
1
, Musculoskeletal Trauma Scored and Recorded Self-Assessment Examination 2015
Musculoskeletal Trauma Scored and Recorded Self-Assessment Examination 2015
Figure 1a Figure 1b
CLINICAL SITUATION FOR QUESTIONS 1 THROUGH 3
Figures 1a and 1b are the radiographs of a 70-year-old retired man who falls
while skiing and injures his right hip. He had no preceding hip pain. After
the fall, he is unable to ambulate and is transferred down the mountain by
the ski patrol and taken to a hospital.
Question 1 of 101
The major blood supply to the femoral head comes from which vessel?
1- Lateral femoral circumflex artery
2- Medial femoral circumflex artery
3- Artery of the ligamentum teres
4- Inferior gluteal artery
PREFERRED RESPONSE: 2 - Medial femoral circumflex artery
2
, Musculoskeletal Trauma Scored and Recorded Self-Assessment Examination 2015
Question 2 of 101
A formal multidisciplinary team approach to the comanagement of geriatric
patients with hip fracture has been shown to lead to
1- decreased intraoperative blood loss.
2- decreased surgical time.
3- decreased inpatient mortality.
4- decreased per-patient costs.
PREFERRED RESPONSE: 4 - decreased per-patient costs.
Question 3 of 101
Which factor is a potential disadvantage of total hip arthroplasty compared
to hemiarthroplasty for treatment of displaced femoral neck fracture in older
patients with higher functional demands?
1 - Increased long-term overall costs
2 - Increased risk for dislocation
3 - Increased risk for revision surgery
4 - Decreased postsurgical function
PREFERRED RESPONSE: 2 - Increased risk for dislocation
DISCUSSION
The main source of blood supply to the femoral head is the deep branch of
the medial femoral circumflex artery. The lateral femoral circumflex artery
and artery of the ligamentum teres contribute to a lesser degree, while the
inferior gluteal artery has a minimal contribution. This vascular supply is
compromised with displaced femoral neck fractures and results in a high rate
of osteonecrosis. This is a reason to consider arthroplasty for older patients
who may not be able to tolerate multiple procedures.
Studies evaluating comanagement protocols for the treatment of hip
fractures in patients older than age 60 have demonstrated significant
improvements in mortality, length of stay, complication and readmission
rates, and ambulatory status at time of discharge while decreasing costs.
3
, Musculoskeletal Trauma Scored and Recorded Self-Assessment Examination 2015
Surgical time, blood loss, time to surgery, and inpatient mortality have not
been altered.
Total hip arthroplasty is more frequently recommended for primary
treatment of displaced femoral neck fractures in older, active patients who
would have otherwise been treated with hemiarthroplasty. Risk for
acetabular erosion is alleviated, implant survival is longer, and revision
surgery rates are lower, as are overall long-term costs. Postsurgical function
is not compromised and may actually be better. Dislocation rates are
increased (up to 10%), although these rates may be lessened with recent
improvements in component design that allow for use of larger femoral
heads.
4
1
, Musculoskeletal Trauma Scored and Recorded Self-Assessment Examination 2015
Musculoskeletal Trauma Scored and Recorded Self-Assessment Examination 2015
Figure 1a Figure 1b
CLINICAL SITUATION FOR QUESTIONS 1 THROUGH 3
Figures 1a and 1b are the radiographs of a 70-year-old retired man who falls
while skiing and injures his right hip. He had no preceding hip pain. After
the fall, he is unable to ambulate and is transferred down the mountain by
the ski patrol and taken to a hospital.
Question 1 of 101
The major blood supply to the femoral head comes from which vessel?
1- Lateral femoral circumflex artery
2- Medial femoral circumflex artery
3- Artery of the ligamentum teres
4- Inferior gluteal artery
PREFERRED RESPONSE: 2 - Medial femoral circumflex artery
2
, Musculoskeletal Trauma Scored and Recorded Self-Assessment Examination 2015
Question 2 of 101
A formal multidisciplinary team approach to the comanagement of geriatric
patients with hip fracture has been shown to lead to
1- decreased intraoperative blood loss.
2- decreased surgical time.
3- decreased inpatient mortality.
4- decreased per-patient costs.
PREFERRED RESPONSE: 4 - decreased per-patient costs.
Question 3 of 101
Which factor is a potential disadvantage of total hip arthroplasty compared
to hemiarthroplasty for treatment of displaced femoral neck fracture in older
patients with higher functional demands?
1 - Increased long-term overall costs
2 - Increased risk for dislocation
3 - Increased risk for revision surgery
4 - Decreased postsurgical function
PREFERRED RESPONSE: 2 - Increased risk for dislocation
DISCUSSION
The main source of blood supply to the femoral head is the deep branch of
the medial femoral circumflex artery. The lateral femoral circumflex artery
and artery of the ligamentum teres contribute to a lesser degree, while the
inferior gluteal artery has a minimal contribution. This vascular supply is
compromised with displaced femoral neck fractures and results in a high rate
of osteonecrosis. This is a reason to consider arthroplasty for older patients
who may not be able to tolerate multiple procedures.
Studies evaluating comanagement protocols for the treatment of hip
fractures in patients older than age 60 have demonstrated significant
improvements in mortality, length of stay, complication and readmission
rates, and ambulatory status at time of discharge while decreasing costs.
3
, Musculoskeletal Trauma Scored and Recorded Self-Assessment Examination 2015
Surgical time, blood loss, time to surgery, and inpatient mortality have not
been altered.
Total hip arthroplasty is more frequently recommended for primary
treatment of displaced femoral neck fractures in older, active patients who
would have otherwise been treated with hemiarthroplasty. Risk for
acetabular erosion is alleviated, implant survival is longer, and revision
surgery rates are lower, as are overall long-term costs. Postsurgical function
is not compromised and may actually be better. Dislocation rates are
increased (up to 10%), although these rates may be lessened with recent
improvements in component design that allow for use of larger femoral
heads.
4
