Exam Pathologies - Neck of Femur Fracture

Exam Pathologies - Module 358

• Neck of Femur Fracture (NOF)
  • Definition: A bone break in the proximal femur, specifically in the region just below the femoral head.
  • Common clinical features include severe pain in the hip or groin after trauma (e.g., fall), inability to bear weight, shortened and externally rotated leg, increased swelling and bruising around the groin and hip.
  • Risk factors include age over 65, female sex (postmenopausal osteoporosis), osteoporosis/osteopenia, falls, smoking, alcohol consumption, and corticosteroid use.
  • Causes include low-energy trauma (common in elderly individuals with osteoporosis), and high-energy trauma (common in younger individuals).
  • Classification by anatomical location: intracapsular (within the joint capsule - sub-capital, transcervical fractures) and extracapsular (outside the capsule - intertrochanteric, subtrochanteric fractures).
  • Complications include avascular necrosis (AVN - disruption of blood supply to the femoral head), non-union (poor healing), deep vein thrombosis (DVT), and post-traumatic arthritis.

Knee Osteoarthritis

• Definition: A degenerative joint disease of the knee, typically due to wear and tear and progressive loss of articular cartilage.
• Risk factors include age, obesity, and previous injuries (trauma, ligament tears, or meniscal injuries).
• Pathophysiological changes include cartilage breakdown/joint space narrowing, bone wearing, and synovial inflammation.
• Cartilage loss reduces joint space and cushioning, while bone rubbing causes pain, inflammation and bone spurs (osteophytes).
• Synovial membrane inflammation leads to pain and swelling by reducing joint lubrication.
• Clinical management goals aim to reduce pain/inflammation, improve joint function and mobility, and enhance quality of life.

Ankle Sprain

• Definition: A ligament injury around the ankle joint, most commonly involving the lateral ligaments due to excessive inversion.
• Clinical features include pain/tenderness over affected ligaments, swelling/bruising around the ankle, reduced range of motion, and difficulty/inability to weight bear.
• Classification includes Grade I (mild – microtears), Grade II (moderate – partial tear), and Grade III (severe – rupture).
• Risk Factors include previous ankle sprains, weak muscles/poor balance, high-risk sports activities, inappropriate footwear, and obesity/poor fitness.
• Management focuses on RICE protocol (rest, ice, compression, elevation) during the acute phase, followed by gentle range of motion exercises, and strengthening exercises (2-6 weeks), balance/proprioception training, and gradual weaning off of braces (6-12 weeks) and referral to physiotherapy for specialized rehabilitation in severe cases.

Shoulder Dislocation

• Definition: Displacement of the humeral head from the glenoid cavity, most commonly anterior.
• Types include anterior dislocations (most common, caused by abduction, external rotation, extension), posterior dislocations (caused by seizures, electric shocks, or trauma), and inferior dislocations (rare, caused by hyperabduction).
• Clinical features include severe shoulder pain, visible deformity (flattened deltoid), limited range of motion, and often numbness and/or tingling (axillary nerve involvement).
• Complications include axillary nerve injury, recurrent dislocations, labral tears, and rotator cuff injuries.
• Management focuses on immediate reduction under sedation/analgesia, then post-reduction imaging to confirm placement, sling immobilization, gradual physiotherapy, and specialized rehabilitation, including surgical intervention for recurrent dislocations or severe damage.

Axial Spondylitis (AxSpA)

• Definition: A chronic inflammatory condition affecting axial skeleton (spine and sacroiliac joints).
• Types include non-radiographic AxSpA (early stage with no visible changes on X-ray but detectable inflammation) and ankylosing spondylitis (AS - advanced stage with visible changes like sacroiliitis).
• Clinical presentation includes chronic back pain, morning stiffness, pain worse at night/early morning, alternating buttock pain (sacroiliac involvement), and fatigue.
• Risk factors include strong genetic association with HLA-B27, more common in males, and family history.
• Management includes NSAIDs, biologics (TNF inhibitors, IL-17 inhibitors) for refractory cases, DMARDs, regular exercise, physiotherapy, and smoking cessation to reduce disease progression.

Stroke (CVA)

• Definition: A disruption of blood flow to the brain lasting more than 24 hours, causing rapid disturbance of cerebral function.
• Types include ischemic stroke (obstruction in cerebral artery) and hemorrhagic stroke (ruptured blood vessel).
• Clinical features (FAST acronym): Face drooping, Arm weakness/inability to lift, Speech difficulty, and Time to call for emergency services).
• Additional symptoms may include sudden severe headache vision changes, balance issues, and dizziness.
• Diagnosis and management typically involve imaging (CT/MRI), blood tests (glucose, cholesterol, clotting profile), cardiac assessment, and focused interventions (thrombectomy, blood pressure control, antiplatelets/anticoagulation).

Parkinson's Disease

• Definition: A progressive neurodegenerative disorder caused by dopamine loss, leading to motor and non-motor symptoms.
• Clinical features include tremor (resting tremor), rigidity (increased muscle tone), akinesia/bradykinesia (slowness/difficulty initiating movements), postural instability (impaired balance).
• Non-motor symptoms include cognitive impairment/dementia, autonomic dysfunction (constipation, orthostatic hypotension), mood disorders, and sleep disturbances.
• Management involves pharmacological therapy (Levodopa+carbidopa, dopamine agonists), non-pharmacological interventions (physiotherapy, occupational therapy, speech therapy), and surgical options (Deep Brain Stimulation) for refractory cases.

Chronic Obstructive Pulmonary Disorder (COPD)

• Definition: A progressive, irreversible lung disease characterized by chronic airflow limitation due to inflammation, airway narrowing, and alveolar destruction.
• Pathophysiology includes inflammation/narrowing of airways (bronchitis), and damage to alveoli (emphysema) from long-term irritants (smoking, pollutants).
• Clinical Features include dyspnea (progressive breathlessness), chronic cough, wheezing, reduced exercise tolerance, and cyanosis (in advanced stages).
• Risk factors include smoking, long-term exposure to air pollutants/occupational irritants, alpha-1 antitrypsin deficiency, and history of recurrent respiratory infections.
• Management aims at smoking cessation, pulmonary rehabilitation, oxygen therapy, bronchodilators (short-acting/long-acting), inhaled corticosteroids, and other supportive measures for exacerbations and respiratory failure.

Coronary Artery Bypass Graft (CABG)

• Definition: A surgical procedure to restore blood flow to the heart by creating bypasses around blocked coronary arteries causing reduced perfusion.
• Purpose is to improve blood supply to the heart, and reduce risk of heart attacks and other complications due to heart disease.
• Indications include severe stenosis of coronary arteries (over 70% narrowing), poor left ventricular function, severe CAD (3 vessel disease), and failure of medical therapy.
• Procedure involves harvesting grafts from veins, arteries or synthetic materials, and creating bypasses by connecting the grafts to the aorta and distal to the blocked segment of the coronary artery.
• Postoperative care involves monitoring ECG, haemodynamics, and potential complications (e.g., graft occlusion, infection, myocardial infarction).

This quiz focuses on the neck of femur fractures, detailing their definitions, clinical features, risk factors, and classifications. It provides essential knowledge for understanding fractures in the proximal femur and their implications. Ideal for students studying pathology or related medical fields.