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Fracture neck femur
This document discusses the anatomy, causes, classification, symptoms, diagnosis, and treatment of hip fractures. It focuses on fractures of the femoral neck. The hip joint is supported by ligaments and supplied by arteries. Femoral neck fractures most commonly occur in older patients due to falls and osteoporosis. They are classified based on displacement and stability. Treatment depends on the fracture type and patient age or health, and may involve closed or open reduction, internal fixation with screws or plates, or replacement arthroplasty. Complications can include nonunion, avascular necrosis, and failure of internal fixation.
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Presentation introduction date and number.
Overview of hip joint anatomy, femur neck fractures including aetiology, mechanism, classification, clinical features, investigations, and treatments.
Details on hip joint ligaments including iliofemoral, pubofemoral, and ischiofemoral ligaments.
Information on the blood supply to the hip joint including arteries such as femoral artery and medial/lateral circumflex arteries.
Causes of femur neck fractures, especially in older patients and trauma in young adults.
Impacted, undisplaced, and displaced fractures of the femur neck.
Primary prerequisites for managing hip fractures, focusing on traction and positioning.
Specific types of femur neck fractures including transepiphyseal, intertrochanteric, subtrochanteric, and transcervical fractures.
Significance of radiography in assessing femur neck fractures.
Emerging techniques for investigating femur neck fractures including oxygen tension measurements, venography, and bone scans.
Goals of early treatment for femur neck fractures including anatomical reduction and internal fixation.
Treatment protocols for different types of fractures according to Garden’s Classification.
Techniques for fracture reduction, including methods suited for different hip positions.
Discussion on the choice of implants for internal fixation of femur neck fractures.
Explanation of blade plate fixation for hip fractures.
Potential complications arising from internal fixation such as infection and nonunion.
Statistics on healing rates post-operative complications linked to inaccurate reduction and poor fixation.
Clinical symptoms indicating femur neck fractures such as inability to bear weight and muscle wasting.
Options for surgical intervention based on the viability of the femoral head.
The incidence of avascular necrosis post fracture and factors impacting head survival.
Approaches to symptomatic treatment of femur neck fractures including bed rest and NSAIDs.
Summary emphasizing the urgency and management techniques for femur neck fractures in the elderly.
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Fracture neck femur
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- 2. • Anatomy ofHip Joint • Fracture femur neck Aetiology Mechanism of Injury Classification Clinical features Investigations Treatment 4/17/2014 2
- 3. HIP JOINT • ArticularCapsule • Iliofemoral ligament • Pubofemoral ligament • Ischiofemoral ligamnet 4/17/2014 3 Ligaments :
- 4. 4/17/2014 4 Principal compressivegroup Ward’s triangle
- 5. 4/17/2014 5 Blood supply: Femoralartery Profunda femoris artery Lateral circumflex arteryMedial circumflex artery EXTRACAPSULAR ARTERIAL RING EXTRA CAPSULAR ARTERIAL RING Retinacular arteries SUBSYNOVIAL INTRACAPSULAR ARTERIAL RING Epiphyseal branchesMetaphyseal branches Artery of ligament teres
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- 8. • Older patients– Osteoporosis or Osteomalacia • Elderly women • Major trauma in young adults like RTA,fall etc. 4/17/2014 8 AETIOLO
- 9. • Trivial fall– direct blow over the greater trochanter • Lateral rotation of the extremity posterior communition of the neck. • Cyclical loading due to muscle force and torsion 4/17/2014 9
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- 22. 4/17/2014 22 It isthe line drawn from the superior margin of the obturator foramen to the margin of neck.
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- 24. 4/17/2014 24 •Oxygen tensionmeasurement •Venography •Intraosseous pressure recording •Isotope scanning •Bone scan with Tc-99m, sulphur colloid, etc.
- 25. 4/17/2014 25 • Earlyanatomical reduction – prevents further vascular damage. • Impaction of fracture fragments • Rigid internal fixation: enables the vascularization from the surrounding soft tissues and uninjured bones – early callus formation.
- 26. 4/17/2014 26 Fracture neckof femur Undisplaced Displaced Physiologically <60 years Physiologically >60 years Closed reduction under x-ray control Prosthetic replacement Reduction possible Reduction not possible Normal hip Hip with pre existing arthritis Multiple screw fixation Open reduction screw fixation hemiarthroplasty THR Conservative Multiple screws
- 27. 4/17/2014 27 Garden I: ConservativeHip Spica for -old fracture. -unfit for surgery. surgical multiple pins by Moore,Knowles cannulated screws. Garden II: fracture fixed with DHS, multiple cannulated AO screws. Gardens III/IV: conservative treatment rarely indicated. SURGERY – anatomical reduction impaction stable internal fixation Treatment plans as per Garden’s Classification
- 28. 4/17/2014 28 Reduction techniques Closedreduction with hip in extension •Whitman’s method •Massie •Mc Elevenny •Deyerle Closed reduction with hip in flexion •Lead better method •Smith Peterson •Flynn
- 29. 4/17/2014 29 INTERNAL FIXATIONfor fracture neck of femur Choices of implants for internal fixation: Multiple pins (Knowles,Moore): - - impacted fractures - medically unfit persons - fractures in children. ASNIS: - provide improved pullout and bending and torque strengths.* Fixed angle nail Sliding or Telescopic nails (Dynamic Hip Screws): nail offers collapsibility continuous impaction at the fracture site lessen the chances of nail penetration.
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- 31. 4/17/2014 31 Blade platefixation:
- 32. 4/17/2014 32 Complications ofInternal Fixation Infection Nonunion Avascular necrosis Loose fixation
- 33. 4/17/2014 33 Meyer’s MusclePedicle Graft:
- 34. 4/17/2014 34 1/3 casesheal with OR+IF Rate – 85-95% * Causes: • Inaccurate reduction • Poor Internal Fixation • Lack of Cambium layer in periosteum. • Avascularity of femoral head • Posterior wall communition Incidece; 40%
- 35. 4/17/2014 35 •Unable tobear weight on affected side •Trendelenberg test +ve •Telescopic test +ve •Wasting of muscles •Minimal shortening of affected limb.
- 36. 4/17/2014 36 Head isviable Head is not viable Osteotomy Acetabular cartilage viable Acetabular cartilage not viable THRHemireplacement arthroplasty Bipolar arthroplasty
- 37. 4/17/2014 37 Due toactual AVN: 2˚ to ischemia Late segmental collapse: due to collapse of subchondral and articular cartilage. INCIDENCE: Aseptic necrosis: 66-84% Late segmental collapse: 7-27% Survival of head depends upon: • Uninjured vascular supply • Revascularization
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- 39. 4/17/2014 39 Radiography Bonescan •Symptomatic treatement:bed rest, NSAIDS. •Displacement or Angulation Osteotomy in early stages. •Hemireplacement arthroplasty •THR.
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- 45. 4/17/2014 45 •An unsolvedproblem •Fracture in elderly •Majority due to trivial fall. •Garden’s classificatio is widely accepted. •It is an Orthopaedic Emergency. •Speed is the watchword in management. •Early anatomical reduction,impaction and rigid internal fixation are the aim of treatment. •DHS and Multiple cannulated cancellous screws is the currently accepted method of fixation. •Nonunion ad AVN are very common.
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