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Fractures of Proximal Femur

1) Fractures of the proximal femur include fractures of the femoral neck, trochanteric fractures, and subtrochanteric fractures. 2) Femoral neck fractures are common in elderly women and often result from indirect rotational injuries caused by falls. They are difficult to treat due to complications like nonunion and avascular necrosis. 3) Fractures are classified based on their anatomy, displacement, and stability to guide appropriate treatment, which includes closed or open reduction and internal fixation using devices like screws, plates, and sliding hip screws.

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71 views38 pages

Fractures of Proximal Femur

1) Fractures of the proximal femur include fractures of the femoral neck, trochanteric fractures, and subtrochanteric fractures. 2) Femoral neck fractures are common in elderly women and often result from indirect rotational injuries caused by falls. They are difficult to treat due to complications like nonunion and avascular necrosis. 3) Fractures are classified based on their anatomy, displacement, and stability to guide appropriate treatment, which includes closed or open reduction and internal fixation using devices like screws, plates, and sliding hip screws.

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Miso
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FRACTURES OF

THE PROXIMAL
FEMUR:
Fracture Neck of Femur,
Trochanteric & Subtrochanteric
Fractures
• Fracture of femoral head
• Femoral neck fractures

(intracapsular fracture neck)


• Trochanteric fractures

(extracapsular fracture neck)


Fracture of the neck of
femur
 It is the Unsolved Fracture
 Because of complications over
which surgeon has no control
 Old age & Sex

 High level of fracture

 Garden Stage III & IV

 Osteoporosis

 ? Avascular necrosis
Structure of Proximal
Femur
Blood Supply of Head of
Femur
Facts about fracture neck
of femur
 Occurs mainly in elderly
women
 Indirect rotational injury

 It is the fracture which

causes the fall


 Happens due to increased

fragility of bone due to


osteoporosis
Clinical Features

 Pain around the hip


 Inability to walk

 Limb looks short &

externally rotated
 Movements of the hip

painfully restricted
 Active SLR not possible
Classification
 Anatomical
 Subcapital
 Transcervical
 Basicervical
Classification
 Direction of fracture angle
(Pauwel’s classification)
Classification
Displacement and fracture instability
(Garden’s staging)

 Stage 1: Incomplete
fracture, with head
tilted in a
posterolateral
direction (Impacted)
Classification
 Stage 2: Complete but undisplaced
fracture.
Classification
 Stage 3: Complete and
partially displaced,
as judged by the
direction of the
trabecular stream in
the head fragment,
but the two fragments
remain in contact
with each other.
Classification
 Stage 4:
Completely
displaced and
the trabeculae
of the femoral
head realign
themselves with
the trabeculae
within the
acetabulum.
Reduction techniques
 Hip in extension:
 Whitmann
 McElvenny
 Deyerle
 Hip in flexion:
 Leadbetter
 Flynn
Evaluation of reduction
1. Heel palm test
2. Garden’s alignment index
Evaluation of reduction
 On the AP view, the angle between
the central compressive
trabeculae within the femoral
head and the medial cortex of the
femur is measured. According to
Garden, this angle is normally
160 degrees
Evaluation of reduction
 On the lateral view, the major
trabeculae are in the same axis
as the axis of the femoral neck
or lie at an angle of 180 degrees
Evaluation of reduction
 Garden demonstrated higher rates
of union and lower rates of
avascular necrosis if alignment
index is between an angle of 155
to 180 degrees and on the lateral
view, he described an acceptable
reduction to be within the same
range of 155 to 180 degrees
Evaluation of reduction
3. Retroversion and anteversion
4. Radiological outline of femoral head
and neck
Fixation devices

 Nails with or without sideplates


 Multiple pins or screws with or
without plates
Fixation devices

 Sliding/Compression devices
Commonly used fixation
devices
 Smith Petersen Triffin nail
 Austin Moore’s pins
 Knowle’s pins
 Asnis or Cancellous screws
 Sliding compression devices
(Richard’s DHS etc.)
Other forms of treatment

 Fixation with muscle pedicle


grafting
 Osteotomies: McMurray, High Femoral
 Arthroplasties: Excision,
Replacement
Advantages of replacement
arthroplasty

 Relatively Quick
 Prompt recovery with early
ambulation
 Early recovery of movements
 Excellent long term results
Complications of fracture
neck of femur
 Nonunion
 Avascular necrosis
 Segmental collapse
 Degenerative arthrirtis
 Chondrolysis
Causes of nonunion of
fracture neck of femur
 Synovial fluid prevents haematoma
formation
 Disruption of blood supply
 Absent cambium layer of
periosteum
 Small proximal fragment
Trochanteric Fractures
 Extra age
 Extra shortening
 Extra external rotation
 Extra swelling
Treatment
Nonoperative:
 Modified Hamilton Russel Traction
Operative:
 Closed/open reduction
 Internal fixation
Aim of Surgery
 To ambulate the patient early so
as to prevent the general
complications of recumbency
Commonly used fixation
devices
 Jewett Nail Plate
 Richard’s Dynamic Hip Screw
 Smith Petersen Nail with
McLauglin Plate
 Gamma nail
 Proximal Femoral Nail
 Locking Dynamic Hip Screw
Complications
 General
 Pressure sore
 Urinary Tract Infection
 Hypostatic Pneumonia
 Deep Vein Thrombosis
 Local
 Malunion
 Coxa Vara
Subtrochanteric Fractures
 More common in young adults
 Through the cortical bone
 Displacement is gross because of
muscle pull
 Delayed or Nonunion is common
Treatment
Nonoperative:
 Modified Hamilton Russel Traction
Operative:
 Open reduction
 Internal fixation
Commonly used fixation
devices
 Jewett Nail Plate
 Richard’s Dynamic Hip Screw
 Reconstruction Nail

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