Scribd
Upload
296 views18 pages

Fracture Neck of Femur

This document discusses the surgical anatomy and treatment of fractures of the neck of the femur (NOF). It covers the vascular supply to the femoral head, classifications of NOF fractures including Garden's and Pauwel's classifications, options for treatment including closed or open reduction with internal fixation using multiple pins or screws/nails, factors influencing treatment choice like age and fracture pattern, and potential complications.

Uploaded by

Praganesh Varshney
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
296 views18 pages

Fracture Neck of Femur

This document discusses the surgical anatomy and treatment of fractures of the neck of the femur (NOF). It covers the vascular supply to the femoral head, classifications of NOF fractures including Garden's and Pauwel's classifications, options for treatment including closed or open reduction with internal fixation using multiple pins or screws/nails, factors influencing treatment choice like age and fracture pattern, and potential complications.

Uploaded by

Praganesh Varshney
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 18

FRACTURE NECK OF FEMUR

BY DR KARTHICK

SURGICAL ANATOMY
Femoral head is not a perfect sphere, slightly oblong. Femoral neck #s are seen in bone that has failed in its capacity to absorb energy impacts. The head & neck received their major blood supply from the subcapital anastomosis formed by retinacular vessels. There is pericapsular vascular anastomosis formed by branches of both femoral circumflex , obturator & superior gluteal arteries. Mainly by medial circumflex arteries.

Calcar femorale Reinforces the femoral neck posteroinferiorly. It nis alaminated vertical plate of condensed bone, fanning laterally from medial cortex to the gluteal tuberosity. Mechanism of fracture A direct blow to the greater trochanter Lateral rotation of the leg. In young due to major trauma or stress #s The head is firmly fixed by anterior capsule & iliofemoral ligament while neck rotates posteriorly.

Healing of # nof Entirely from intramedullary endosteal callus. Revascularisation Of the head occurs from the areas which remain viable, vascular ingrowth from the disatl fragment & capillary ingrowth.

Treatment of # nof Classification GARDENS

A O CLASSIFICATION

PAUWELS CLASSIFICATION

INITIAL MANGEMENT No traction is needed as it causes increase intracapsualr pressure. Limb is kept in position of external rotation and flexion which allows for maximal capsular volume.

DECISION MAKING
IMPACTED # NOF Are stable #s. #s in position of varus or retroversion, greater than 30 deg are unstable and require internal fixation which should be done insitu. Multiple pins should be used

DISPLACED #NOF
High incidence of AVN of the femoral head Consider the factors for treatment Age, type of #,viability of head, posterior communition, osteoporosis, associated disease. Treat with multiple pins, with or without muscle pedicle graft, arthropalsty.

Choice of implant
JC Dilees classified implants used into Multiple pins or screws-better medial anchoring even in osteoporotic bones., least risk of disimpaction, do not penetrate into hip joint, finer correction of reduction with lag screws. Fixed angle nail Sliding or telescoping nail Sliding screw and barrel plate

Preferably to be fixed within 12 hrs preferably. Barnes et al concluded that delay upto 7 days does not cause significant increase in incidence of nonunion or avn. Anatomic reduction is crucial.

Whitman- traction with limb in extension internal rotation abduction Leadbetter reduction with hip in full flexion. Reduction in flexion- fesxion at hip in (0 and leg ext rotated to disengage. Traction external rotaion hip is extendede and internally rotated. Smith Petersen- traction with hip in flexionint rotation abduction & extension.

Types of malreduction Valgus reduction- slight is acceptable, excessive valgus causes further damage to the vascularity. Varus reduction- not acceptable, as shearing forces will lead to nonunion. Anteversion- corrected by pressing greater trochanter from behind & pressure on head from anteriorly. Retroversion- corrected by prssing trochanter from anterior aspect. Rotatory malreduction-difficult ot evaluate After 3 attempts abandon close reduction

Non operative treatment for bedridden , with mental illness, certain impacted and stress #s Simple multiple pinning for patients with poor medical condition, impacted #s Muscle pedicle graft- in young with severe posterior communition Prosthetic replacement for nonviable head, poor reduction, parkinsons, severe osteoporosis and delay for more than 3 weeks. Girdle stone for infected hip

Complications
Early Infection, DVT Late Malunion, nonunion ,aseptic necrosis, heterotopic bone, pain

Nonunion
TreatmentHead preserving proceduresOsteosynthesis with fibular graft Osteotomies- pauwels abduction osteotomy, Blounts angulation osteotomy, mcmurrays intertrochanteric osteotomy Muscle pedicle graft of meyers Arthroplasty- HRA

You might also like