Proximal Femoral Neck and intertrochanteric fractures
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Femoral Neck Fracture by dr. Ali Kareem University of Al Nustansiriyah college of Medicine Baghdad\ IRAQ 2018
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Proximal Femoral Neck and intertrochanteric fractures
- 1. Proximal femoral neck & inter trochanteric fracture Presented by final year medical student Ali Kareem 5/2/2017 1 Orthopedic branch – Surgery department - MUCOM
- 2. • The structure of the head and neck of femur is developed for the transmission of body weight efficiently, with minimum bone mass, by appropriate distribution of the bony trabeculae in the neck. • Femoral neck fracture is one of the most common injuries observed in the elderly leading to morbidity and mortality. • commonly seen in the women (femalemale ratio is 31 5/2/2017 Footer Text 2
- 3. Risk factors A. Osteoporosis. B. High speed energy trauma C. Pathological fracture. 5/3/2017 Footer Text 3
- 4. Blood supply 5/3/2017 Footer Text 4 A. extracapsular arterial ring ❖ lateral &medial femoral circumflex artery B. ascending cervical branches ( Retinacular arteries) C. the arteries of the ligamentum teres (foveal artery).
- 6. Classifiatiom of F. neck fracture Gardens classification • G1: incomplete impact fracture of the femoral neck. • G2 : complete non displaced Fracture • G3 : complete fracture with moderate displacement. • G4 : severely displaced fracture 5/3/2017 Footer Text 6
- 9. MECHANISM OF INJURY ⮚ Low-energy trauma (most common in older patients) - Direct: A fall onto the greater trochanter (valgus impaction) or forced external rotation of the lower extremity impinges an osteoporotic neck onto the posterior lip of the acetabulum (resulting in posterior comminution). - Indirect: Muscle forces overwhelm the strength of the femoral neck 5/3/2017 Footer Text 9
- 10. ⮚ High-energy trauma- accounts for femoral neck fractures in both younger and older patients, such as motor-vehicle accident or fall from a significant height. ⮚ Cyclical loading-stress fractures: These are seen in athletes, military recruits, ballet dancers; patients with osteoporosis and osteopenia are at particular risk. 5/3/2017 Footer Text 10
- 11. • This case is very common in elderly women nearly 80% who have tripped and fallen while walking. • Main symptoms : pain in the region, eccomyosis inner side of the thigh. • Difficulty & inability in walking • Dx is confirmed by X-Ray of the hip loint in both anterior & lateral position 5/3/2017 Footer Text 11
- 14. Diagnosis Situations in which femoral neck fracture may be missed- ⮚ Stress fractures- elderly patient with unexplained pain in the hip should be considered to have stress fracture until proven otherwise. ⮚ Undisplaced fracture-impacted fracture may be difficult to visualise on plain x-ray. ⮚ Painless fracture-a bed ridden patient may develop a silent fracture. 5/3/2017 Footer Text 14
- 15. ⮚Multiple fractures-patient with a femoral shaft fracture may also have a hip fracture which is easily missed unless the pelvis is x- rayed. 5/3/2017 Footer Text 15
- 16. Treatment 5/3/2017 Footer Text 16 • Conservative Treatment Fractures at this level have a poor capacity for union due to the following factors. • Interference with the blood supply to the proximal fragment. • Difficulty in controlling the small proximal fragment. • The lack of organisation of the fracture haematoma due to the presence of the synovial fluid.
- 17. Treatment Surgically:- 1. the fracture can be fixed by multiple cancellous screws, pin plate, dynamic hip screw. 2. a prosthesis can be used to replace the head and the neck of the femur, in complete transverse fracture the replacement is said to be complete (total hip replacement). 5/3/2017 Treatment 17
- 18. Complications 1. Non union 2. Avascular necrosis 3. Osteo-arthritis 4. Dislocation (in replacement method) 5/3/2017 Footer Text 18
- 20. Pathoanatomy ❖ The distal fragment rides up so that the femoral neck-shaft angle is reduced (Coxa vera). ❖ The fracture is generally comminuted and displaced. ❖ Rarely it can be undisplaced fracture. 5/3/2017 Footer Text 20
- 21. Diagnosis Clinical features:- • History of a fall or RTA. • Pain in the region of the groin and inability to move the leg. • Swelling in the region of the hip, and the leg will be short and externally rotated. • Tenderness over the greater trochanter. • Physical findings are more marked. 5/3/2017 Footer Text 21
- 22. Radiological features:- • X-ray- presence of comminution of the medial cortex of the neck • avulsion of the lesser trochanter • extension of the fracture to the subtrochanteric region indicate an unstable fracture. 5/3/2017 Footer Text 22
- 24. Treatment Conservative in :- • Poor medical and surgical risk patients • Terminally ill patients • Very old patients Methods 1. Simple support with pillows 2. Buck’s traction 3. Plaster spica 4. Skin or Skeletal traction through distal femur or tibia for 10 – 12 weeks 5/3/2017 Footer Text 24
- 28. Operative methods:- • The fracture is reduced under x-ray control and fixed with internal fixation devices. Most commonly used are, • Dynamic hip screw (DHS). • Nails such as Proximal Femoral Nail (PFN). 5/3/2017 Footer Text 28
- 29. Complications • Malunion • Coxa vara • Traumatic Osteoarthritis 5/3/2017 Footer Text 29
- 31. 5/3/2017 Best regards .. 31