The document discusses a case of a 55-year-old male who suffered a neck of femur fracture following a fall, detailing his symptoms, examination findings, treatment via surgery, and postoperative recovery. It highlights the importance of timely intervention to restore blood supply and outlines the epidemiology, classification, diagnosis, complications such as avascular necrosis, and treatment options for neck of femur fractures. The conclusion emphasizes that these fractures are common and require surgical intervention, while also noting the risks of osteonecrosis.

1. NECK OF FEMUR FRACTURE
Manish Uprety MODERATOR: DR. BIBEK BASUKALA
Intern
Department of Orthopaedics and Traumatology

2. CASE HISTORY
• 55 Years male , Ramechhap
• 9th October 2012, 7 hours
• H/O fall from about 10 feet height
• Sustained Injury over Right groin
• Complain of Pain and inability to walk

3. EXAMINATION
• Tenderness over Right Hip Region
• Attitude: Flexion, abduction and external rotation
• No Ecchymosis
• ROM Painful
• Distal neurovascular status : intact

4. X-RAY

5. CLOSED REDUCTION and CANNULATED
CANCELLOUS SCREW FIXATION.

6. • Post-operative period and recovery: uneventful
• Patient : happy

7. • Pain at the right groin region
• Difficulty in movement
PROBLEM STARTED AFTER 4 YEARS

8. AVASCULAR NECROSIS OF HEAD OF RIGHT FEMUR

9. SCREWS REMOVED : AVN STAGE III

10. TOTAL HIP ARTHROPLASTY

11. FEMORAL NECK FRACTURE

12. ANATOMY OF NECK OF FEMUR

13. BLOOD SUPPLY
Extracapsular arterial
ring
Arteries of the
ligamentum teres
Retinacular arteries

14. FRACTURE NECK OF FEMUR: AN
ORTHOPAEDICS EMERGENCY….WHY?
Restore blood supply of head of femur ASAP

15. EPIDEMIOLOGY
• Constitutes 50% of all hip fracture
• Most commonly seen in Elderly (6/7th decade)
• Even minor fall or trivial trauma ( osteoporosis )
• Young adults : high velocity trauma

16. CLASSIFICATION
• ANATOMICAL LOCATION

17. PAUWEL CLASSIFICATION
• Based on angle of fracture line to horizontal

18. GARDEN’S CLASSIFICATION
• Based on Degree of Displacement of fracture.
Type I: Incomplete/valgus
impacted
Type II: Complete and
nondisplaced

19. Type III: Complete
with partial
displacement
Type IV: Completely
displaced- Worst Prognosis.

20. USUAL PRESENTATION
• elderly after minor fall.
• pain at the hip joint and inability to move hip
joint
• Typical attitude
• Shortening of leg
• Attempted hip movement painful

21. DIAGNOSIS
• Usually plain x-ray suffices
• If confusion we have to do CT
• MRI: to diagnose stress fracture and to see
viability of head

22. COMPLICATION
• Avascular necrosis of head of femur
TREATMENT: CORE DECOMPRESSION
THR
• Non-union: OSTEOTOMY
• Osteoarthritis: THR

23. CONCLUSION
• NECK OF FEMUR FRACTURE: COMMON
• TREATMENT ALWAYS SURGICAL
• ORTHOPAEDICS EMERGENCY
• POSSIBILITY OF OSTEONECROSIS SHOULD BE ALWAYS
EXPLAINED

24. References
• Essential Orthopedics- Maheshwari and Mhaskar.
( 5th edition)
• Apley’s System of Orthopaedics and Fractures.
( 9th Edition)
• Campbell Operative Orthopedics (12th Edition)
• Orthobullets
• Medscape