Fracture Neck Femur: DR Abhishek Pathak Assistant Professor Orthopaedics

FRACTURE NECK FEMUR
DR ABHISHEK PATHAK
ASSISTANT PROFESSOR
ORTHOPAEDICS
http://www.esnips.com/web/apathak
ANATOMY
NORMAL
NECK SHAFT
ANGLE IS 135
DEGREE
ANTEVERSION = 10 ± 7º
CALCAR FEMORALE
• Calcar femorale is a
Condensed plate of
bone extending from
lesser trochanter to
greater trochanter
posteromedially
TRABECULAR SYSTEM
FRACTURE NECK OF FEMUR
Variously called as
• The unsolved fracture
• Fracture of necessity
WHY
• EVEN WITH A GOOD REDUCTION AND FIXATION
ABOUT 30% GO INTO NON-UNION / AVN
• SURGEON HAS SOME CONTROL OVER NON-UNION

BUT NOT OVER AVN
• INCIDENCE OF NON-UNION CAN BE GREATLY

REDUCED BY EARLY REDUCTION AND INTERNAL
FIXATION
• AVN DEPENDS ON THE INITIAL TRAUMA AND

DISPLACEMENT OF THE FRACTURE
REASONS FOR NON UNION
1. INTRA-ARTICULAR FRACTURE THUS SYNOVIAL
FLUID A DETERRENT TO # UNION
2. VASCULARITY PRECARIOUS
3. PERIOSTEUM IS LACKING THUS THE UNION IS

ENDOSTEAL
4. # SUBJECTED TO HIGH SHEARING FORCES
5. BONE QUALITY MAY NOT BE GOOD
BLOOD SUPPLY
• Lateral epiphysel artery
– terminal branch MFC artery
– predominant blood supply
to weight bearing dome of
head
• Artery of ligamentum
teres
– from obturator artery
– supplies anteroinferior
head
• Lateral femoral circumflex
a.
– less contribution than MFC
• Three ligaments in this region
1) Ileofemoral
2) Pubofemoral
3) Ischiofemoral
• 1575- Ambroise Pare described I/C # neck femur
• 1850- Lagenbeck nails a hip
• 1904- Whitman’s reduction and spica cast
• 1931- Smith-Peterson used his triflanged nail
• 1936- Moore’s pin and Knowle’s pin
• 1943- Moore’s prosthesis
• 1952- Thompson’s prosthesis
• 1960- Charnley’s Total Hip Arthroplasty
EPIDEMOLOGY
• Common fracture to occur in old female

usually due to post menopausal osteoporosis
• Average year of occurrence is 60-70
• Young adults are involved in high energy
trauma
Risk factors include
1. Female sex
2. Alcohol and tobacco use
3. Previous #
4. Low estrogen level
MECHANISM
• Low energy trauma in elderly patients
– Direct: Fall on GT or forced ext.
Rotation
– Indirect : Muscle forces overwhelming
bone strength
• High energy trauma : RTA, Fall from
height
• Cyclical loading can cause stress fractures
Clinical evaluation
• H/o trivial trauma after which the patient is non
ambulatory
• Pt. with impacted fracture may bear weight
• ½ to 1 cm of shortening
• Limb in mild ext. rotation as compared to normal
limb
• Pain in groin
• Tenderness at the base of Scarpa’s Triangle
• Pain on hip movt.
• Axial tenderness
Inguinal
Ligament
Medial border of
adductor longus
Medial border of
sartorius
IMAGING
• X-ray pelvis with both hips AP view
• X-ray of affected hip AP and Lateral
view
• Internal rotation AP views
• Tech. Bone Scan
• MRI
ANATOMICAL CLASSIFICATION
PAUWELS CLASSIFICATION
• ANGLE THAT FRACTURE LINE SUBSTANDS

WITH THE HORIZONTAL
Garden Classification
I - Incomplete or Impacted
II - Complete no displacement
III - Complete with partial displacement
IV- Complete with total displacement
GARDENS CLASSIFICATION
• GARDEN’S TYPE I
• GARDEN’S TYPE II
• GARDEN’S TYPE III
• GARDEN’S TYPE IV
SHENTON’S LINE
SHENTON’S LINE
Goals of treatment
• Minimize patient’s discomfort
• Restore hip function
• Allow rapid mobilization by early
reduction and internal fixation so as
to avoid problems of long term
recumbency
NON OPERATIVE
TREATMENT
• No place in todays time
• Recommended only for patients who are
at extreme medical risk, moribund or
demented nonambulators
TREATMENT
OPTIONS
DISPLACED FRACTURE IN
YOUNG ADULTS
• # LESS THAN 3 WEEKS OLD
• OPEN OR CLOSED ANATOMIC

REDUCTION WITH STABLE INTERNAL
FIXATION WITH
a) 6.5 mm CCS, optimum 3 in number
b) DHS with a derotation screw
DHS with a derotation screw
6.5 mm CCS, optimum 3 in
number
FRACTURES IN CHILDREN
• Closed reduction and internal fixation
with
a) Moore’s pin
b) Knowles pin
Followed by spica cast immobilization
CRITERIA FOR ANATOMIC
REDUCTION
• Garden’s criteria : Trebacular angle
on AP and Lat. view should be within
the range of 160-180 deg.
• Lovetts “LAZY S” criteria
FRACTURE > 3 WK. OLD
• OSTEOTOMIES:
McMurray’s Provide arm chair
effect
Valgus angulation
1. MUSCLE PEDICLE GRAFT
1. Meyer’s quadratus femoris pedicle
2. Bakshi’s TFL pedicle graft
2. GIRDLESTONE EXCISION
ARTHROPLASTY
3. ARTHRODESIS
4. ORIF WITH FIBULAR GRAFT
# N/F IN ELDERLY > 60 YRS
• Physiological age is important.
• HEMIARTHROPLASTY
UNIPOLAR : 1) Austin Moore prosthesis

2) Thompson prosthesis
BIPOLAR PROSTHESIS
• THR- when acetabular erosion is present

Austin Moore prosthesis
BIPOLAR PROSTHESIS
THR
STRESS FRACTURE
COMPLICATIONS
• Non union
• AVN
• Limb length dicrepency

Fracture Neck Femur: DR Abhishek Pathak Assistant Professor Orthopaedics

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Fracture Neck Femur: DR Abhishek Pathak Assistant Professor Orthopaedics

Hochgeladen von

Copyright:

Verfügbare Formate

FRACTURE NECK FEMUR

• SURGEON HAS SOME CONTROL OVER NON-UNION

• INCIDENCE OF NON-UNION CAN BE GREATLY

• AVN DEPENDS ON THE INITIAL TRAUMA AND

3. PERIOSTEUM IS LACKING THUS THE UNION IS

4. # SUBJECTED TO HIGH SHEARING FORCES

5. BONE QUALITY MAY NOT BE GOOD

• Common fracture to occur in old female

• ANGLE THAT FRACTURE LINE SUBSTANDS

• OPEN OR CLOSED ANATOMIC

Followed by spica cast immobilization

UNIPOLAR : 1) Austin Moore prosthesis

• THR- when acetabular erosion is present

Das könnte Ihnen auch gefallen