This document discusses the treatment of hip fractures, including: - Extracapsular fractures are treated with sliding hip screws, cephalomedullary devices, or fixed angle devices. Cephalomedullary devices are best for unstable fractures as they act as a buttress. - Intracapsular fractures are treated surgically or with arthroplasty depending on the patient's age, bone quality, and fracture displacement. - Proper surgical technique is important, including closed or open reduction to achieve alignment and compression at the fracture site. Device choice depends on the specific fracture pattern and stability.

1. *

2. *
*Extracapsular fractures (pertrochanteric
fractures)
*Intracapsular fractures (neck of femur)

3. *

6. *
*Posteromedial comminution (calcar)
*Subtrochanteric extension / reverse oblique
*Involvement of lateral cortex

7. *
*Sliding hip screw (SHS)
*Cephalomedullary device
*Fixed angle device

8. *
*For stable fractures
*Provide compression at fracture site
*Failure rates up to 12.5% reported
*Limited ability to resist fracture collapse and
medialization
*High failure in reverse oblique
*8 fold increase in failure rate in unstable
fractures (Palm et al. 2007)

9. TAD
should be
<25mm

10. *
*Best for unstable fractures
*Provides shorter lever arm – reduced bending forces
compared to SHS
*Acts as buttress to proximal femur
*Prevents medialization of shaft
*Biological advantage – less soft tissue disruption
*Femur fracture known complication of short nails
*No advantage over SHS in stable fractures

11. (a) Reverse obliquity fracture
(b) Cephalomedullary device acts as buttress to resist lateral displacement
of prox femur

12. Shorter lever arm in CMD – reduce bending forces

13. *
*DCS or blade plate – both at 95 degrees
*Infrequently used now
*No fracture impaction
*Increase femur head penetration if fracture collapse
*Blade plates
*Resist prox femur lateral translation
*Can be used in reverse oblique fractures – better than
SHS (Haidukewych et al. 2001)
*Has use in revision op – engage bone lower in femoral
head

16. *

20. *
*In undisplaced fracture – all can fix
*<60 years old – reduce and fix
*>80 years old – arthroplasty
*Type of arthroplasty best – no definitive study yet
*60 – 80 years old – opinions vary
*Good bone stock – can still reduce and fix
*But latest studies show more complications in
this age group if fix
*Therefore: own preference
Displaced
fractures

21. *
*Proper reduction is most important
*Gentle traction with internal rotate
*If failed closed, do open reduction – Watson Jones
approach preferable
*If highly comminuted – valgus deformity is more
stable
*If varus angulation of 20 degrees a/w 55% risk of
failure (Arnold et al 1984)

22. *
*Majority by cannulated screw or SHS with
derotational screw – provided can get
compression with loading (pauwels 1 + 2)
*In pauwels 3 – high shear forces – best with
fixed angled device

25. Pauwel osteotomy for vertical NOF fracture

26. *

27. *
*Remove haemarthrosis
*By aspirate or capsulotomy
*Postulated to reduce intracapsular pressure
*Timing of surgery
*Conflicting evidence
*Osteocyte death occurs slowly (2-3 weeks)
*Fix after 7 days no effect on rate of non-union or
AVN (Barnes et al 1976)
*16% rate of AVN in >12 hours fixation delay (Jain
et al 1994)

29. *
*Extracapsular – fracture stability determines
decision
*Intracapsular – patient’s age, displacement and
bone quality determines decision

30. *