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INTRACAPSULAR FRACTURE NECK OF FEMUR.ppt
- 1. INTRACAPSULAR FRACTURE NECK OF FEMUR Dr.J H VIDYA SAGAR MS ( Ortho), DNB, FIJR ASSISTANT PROFESSOR OSMANIA MEDICAL COLLEGE
- 2. Anatomy Physeal closureage 16 Neck-shaft angle 130° ± 7° Anteversion 10° ± 7° Calcar Femorale Posteromedial dense plate of bone calcar
- 3.
- 4. Profunda Femoris artery gives medialand lateral circumflex arteries These two form the Extra capsular arterial ring Blood Supply to Proximal femur
- 5. Blood supply tothe Femoral Head This arterial ring gives retinacular vessels which go along the neck of the femur so they are called ascending cervical arteries
- 6. Blood Supply tothe femoral head These form a ring just below the head called the Sub Synovial Intra Articular arterial ring From this intra articular ring of arteries epiphyseal vessels go into the head of the femur Head is also supplied by the artery of ligamentum teres
- 7. Vascular Anatomy ofFemur
- 8. Bony Trabecular Patternin Proximal Femur Calcar femorale
- 9. Fracture of Neckof Femur Intra – Capsular Fracture of Proximal Femur
- 10. “We come tothe world under the brim of pelvis and go out of the world thru the neck of the femur” Enigma of an Orthopedic Surgeon
- 11. Types Intra Capsular – –Subcapital – Transcervical – Basal
- 12. Extra Capsular – –Inter Trochanteric – Sub Trochanteric
- 13. Why fractures ofneck fail to heal? No Cambium layer in the intra capsular area, so peripheral callus Synovial fluid lyses the fracture hematoma Avascularity of the head is imminent due to the peculiarity in the blood supply
- 14. Etiology Osteoporosis in elderlypatients Usually lateral rotation of femur cracks the fragile neck and then the patients fall Osteomalacia in the young Major trauma in young adults
- 15. Fracture of Neckof Femur Most of these are displaced A few are impacted.
- 16. Anatomical Classification Dependingon the place of the fracture Into – – Sub capital – Trans Cervical – Basal
- 17. Pauwel’s Types Depends onthe angle the fracture line makes with the horizontal
- 18. Garden’s Classification Garden IGarden II
- 19. Garden’s Classification Garden IIIGarden IV
- 20. Garden Classification I Valgusimpacted or incomplete II Complete Non-displaced III Complete Partial displacement IV Complete Full displacement
- 21. Plain Film – Considertraction-internal rotation view if comminuted CT scan – Displacement – comminution Diagnosis
- 22. 22 MRI – For evaluationof occult femoral neck fracture • Consider MRI in an elderly patient who is persistently unable to weight bear – 100% sensitive and specific Diagnosis
- 23. Treatment Goals: Geriatric Patients Mobilize –Weight bearing as tolerated – Minimize period of bedrest Minimize surgical morbidity – Safest operation – Decrease chance of reoperation
- 24. Treatment Depends on theage of the patient Aim in children, young adults and upto 60 Y – save the head – Risk of non-union and avascular necrosis of the head is always there After 60 Years or if the bone is osteoporotic – replace the head
- 26. In patients lessthan 16 Y The capital epiphysis is open and viable Try to protect it Closed reduction under C-arm control and fixation with Austin Moore Pins (Smooth)
- 28. Patients above 16-18Y Epiphysisis fused, no more growth expected Closed reduction under C-arm control and fixation with cancellous screws If it is more than 3 weeks old – fix it and graft it with muscle pedicle graft
- 29.
- 30. Good Union after3 Months
- 31.
- 32. In old patients Headis osteoporotic No chance of healing of fracture Hemi replacement with – Austin Moore prosthesis if the calcar is present – Thompson's prosthesis if the calcar is absent
- 33. Fracture of Neckin old Hemireplacement Arthroplasty
- 34. Patient is anold geriatric There will be lot of oteoporosis Femur will also be weak The prosthesis may sink So cemented prosthesis – cement in the shaft of femur holds the prosthesis from sinking
- 35. Case example 78 Yold lady H/O trivial fall one month ago H/O Hemi-replacement on one hip an year ago The other one is painful after fall
- 36. Case The previousone is the cause of fall???
- 37. Case Problems Gross osteoporosis Absorbed neck Wide medullary canal
- 38.
- 40. Complications Post-traumatic arthrosis • Jointpenetration with hardware • AVN related Blood Transfusions – THR > Hemi > ORIF – Increased rate of post-op infection DVT / PE – Multiple prophylactic regimens exist – Low dose subcutaneous heparin not effective
Editor's Notes
- #21 For plain film-may add internal rotation when radiograph obtained