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So I know we have two. Cool. Let's see if that's working. I'll also message one of the members and just, oh yeah, it should be live now. Ok. And I will message someone just to double check that we are connected. Great. Yeah, I'm thinking, I'm just gonna wait 12 minutes just to see if someone like logs in last minute and then we can probably, there'll be like a few stragglers for sure. Evening is always a bit of an awkward time because at home. Yeah. Oh, yeah, we're all, we're all good. Everyone can hear us and see. Great. So, ok, it's one minute past seven. I think I'm gonna start and if someone joins then they can just come up on the slides. Ok. So, good evening everyone. My name is Susanna. I'm one of the CT trainees in tr on orthopedics. And today we're gonna do a talk on hip fractures. So I can see there are two people viewing the lecture. Um, so if you could tell me which year you're in and if you've had any orthopedic experience before, that'd be great because then I kind of know what kind of level of experience you have and if you've seen any patients with hip fractures. So I don't know if there's an option to like unmute yourself. And oh, if not, you can just text in a chat. Cool. So, um, whilst you're typing away, I'm just gonna tell you what we're gonna cover today. Um So we'll start with hip anatomy. We'll talk about blood supply the bony structures of the hip and the muscles surrounding the hip. Um Then we're gonna talk about the presentation etiology, management of hip fractures. Um Then we can talk about fracture classification because that's the blueprint of orthopedics. Once you master the classification of fractures, uh that will pretty much guide you as to how to manage them. Then we'll talk a little bit about the operations that you can do for fractured neck of femur. Uh because these are the operations that you'll most commonly see on the orthopedic placement. And then we'll finish the talk by um talking about postoperative complications in patients with hip fractures. Um So I can see that Elita wrote on the child that she's in fourth year was an Ortho theater in year too. So only arthroscopy, but not much besides that. Great. So you're in fourth year, you have your finals at the end of the year. Um So if there's one thing that you need to know from orthopedics, that's hip fractures and hopefully this lecture will cover everything that you need to know for your exams. Ok. So let's start by hip anatomy. Um So hip is the large, the largest weight bearing joint in the body. It is compromised of, it's comprised of two bones which is the acetabulum, which is this um convex structure in the pelvis and the head of the humor. So the most proximal part of the femur uh these two joints articulate in what's called a synovial joint that's lined by synovial membrane and synovial fluid. And it's a ball and socket type of joint which allows movement in three planes because you can um flex and extend your hip, you can abduct and abduct and you can also internally and externally rotate the hip. So it's a very mobile joint and that allows plenty of movement and it also allows to, allows us to walk and takes the whole weight of our body. So when we look at the plain x ray of the hip joint, there are a couple of really important structures that we need to be aware of. So the first structure that you can see highlighted here at the top is the greater trochanter. And that's this bony prominence of the top of the femur. Basically, there are a couple of important muscles that attach the greater trochanter and these are your glutes. So the hip external rotators. So it's your gluteal gluteus, minimus and gluteus medius. Then at the bottom, you have a second important structure in the hip joint with a lesser trochanter. So that's another small mo more distal prominence. And this is a bony attachment for a couple of other important muscles such as your adductors and your ileos muscle that causes hip flection. Why they are important these two trochanters because between them lines, this line called intertrochanteric line between the top of the Great Atro counter and the bottom of the less Atro caner. And that's really important because that's where the joint capsule starts. And that's what demarcates the blood supply to the hip joint. And also later when we look at the classification of hip fractures, above that intertrochanteric line, we're gonna have fractures that are intracapsular because they are in hip capsule. And below that intratrochanteric line will have extracapsular fractures because they will be outside of hip capsule. So these are the muscles I've mentioned that attach to greater trochanter. So you can see gluteus, medius and gluteus minimus and lesser trochanter. You can see iliopsoas muscle attached and these muscles are important because when we have fractures below the Nero feur, they pull the bone in different places and they can displace the fracture. So why don't we talk about hip capsules? So there are a couple of important ligaments that we need to be aware of that form that hip capsule. So looking at that picture in front of us, we can see greater trochanter and we can see lesser trochanter and essentially around the hip joint. There are five important ligaments that are very tightly connected, that form a very firm ligament structure that prevent the hip from dislocating. But they also provide a passage for very important blood vessels that carry the blood supply into the hip joint. So, once these ligaments are disrupted, the blood supply is also disrupted. And that's when the head of the humerus can die off in hip fractures. So the five ligaments that um constitute the hip capsules are the iliofemoral ligament. So, the one that goes from the femur to the ilium of the pubic bone, ischiofemoral ligament. So the one that goes from the EUM of the pubic bone to the femur, pubofemoral hi pubofemoral ligament. So the one that goes from the pubic rami to the uh femur. And then we also have two additional ones which is zona orbicularis, which is this large round ligament wrapping around the neck of the femur. And we also have a have a small ligamentum terrace that is in the middle of the acetabulum and in Children and in young adults, that's the passage for the foveal artery uh that can also supply blood to the hip joint. So now let's look at the um blood supply to the hip joint itself. So the main source of blood supply to the hip joint in a in an adult comes from the external iliac artery. So we have our abdominal aorta that then branches off into common iliac arteries left and right, then common iliac artery branches off into internal iliac and external iliac artery. External iliac artery then travels down, travels through the inguinal ligament. And then once it travels past the inguinal ligament, it becomes the femoral artery. And at the level of the hip joint, femoral artery gives off what's called a profunda femoris artery. And this is the main artery supplying the hip joint, profunda femoris artery then gives off two branches. One is the lateral circumflex, femoral artery. And the other one is the medial femoral uh medial circumflex, femoral artery. And they tightly wrapped around um the neck of the femur and then they give off the retinacular arteries inside the hip capsule to give the blood supply to the head of the femur. And this is what we call a retrograde blood supply because usually the blood travels in the body from the, from the top to the bottom. But in the hip joint that doesn't happen in the hip joint, you have blood supply pred predominantly from the distally sided vessel, which is the profunda femoris artery, giving branches traveling proximately. So to the top to the, to the neck of the femur, and that's what makes the head of the femur so vulnerable in fractures because that blood supply becomes compromised. And that's why you um the head of the femur dies off and fractures. And that's why these fractures are so problematic and often require surgery as we'll look into it later. And then one important caveat when you're a younger child or?