neck of femur fractures (2)
TRANSCRIPT
Neck of femur fractures
Contents
• INTRODUCTION
• ANATOMY
• MECHANISM OF INJURIES
• CLASSIFICATION
• APPROACH TO NECK OF FEMUR FRACTURES
INTRODUCTION
• Neck of femur fractures are more common amongst the elderly patient.
• Risk factors involved in femur fractures are as follow:
1. Osteoporosis
2. Women
3. Low soscioeconomic status
4. Cardiovascular disease
5. medication
ANATOMY
• PLEASE SEE PAGES 478-486 IN ATLAS OF HUMAN ANATOMY
Mechanism of injury
• Falling directly onto the hip
• Twisting mechanism
• Sudden completion if an impartial fracture
• In the young patients it is common after trauma such as MVA and PVA
classification
• The Garden classification is used to classify neck of femur fractures
1. Type1: impaction fracture
2. Type 2: non-displaced fracture
3. Type3: varus displacement of the femoral head
4. Type4: complete loss of the continuity amongst fragments
• Garden classification system of femoral neck fractures. (A) Garden I fracture: incomplete and minimally displaced. The fracture shown is impacted and is in valgus malalignment. (B) Garden II fracture: complete, nondisplaced. (C) Garden III fracture: complete fracture and partially displaced. The fracture shown is in varus malalignment. (D) Garden IV fracture: completely displaced, with no engagement of the 2 principal fragments
Approach to femur fractures
• History
• Co-morbidities
• Cause of the fall
• DVT prophylaxis
• Timing of surgery
Surgery…..
• ORIF VS ARTHROPLASTY
Neck of Femur #
Undisplaced (Garden I-II) Or
Valgus Impaction
Internal Fixation
Displaced (Garden III-IV)
<65 yr oldGood bone qualityNo OA changesStable # pattern
Satisfactory, early reductionStable fixation
Closed reduction +
Cannulated screws
>65yrPoor bonestockOA of hip joint
Unstable fracture patternReduction unobtainable or >1/52
Stable fixation not possible
HealthyActiveYoung
Low risk for dislocationOA/RA Present
THR
Significant comorbid disease
Low demandElderly
High risk for dislocationOA/RA Absent
>5yr life expecta
ncy
Bipo lar Hemi-arthro plasty
<5yr life expecta
ncy
Unip olar He mi-arthro plasty
Non-ambulatoryNon-operable
Relatively painfree
Non-operative
management
COMPLICATIONS
• INFECTIONS
• THROMBOEMBOLISM
• CHRONIC PAIN
• DISLOCATION
• NON-UNION
• AVASCULAR NECROSIS
• POST TRAUMATIC ARTHRITIC CHANGES
RESOURCES
• Atlas of human anatomy(Frank H. Netter)
• Uptodate
• www.google.com
• medscape