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Femoral bone fracture "neck & shaft fractures"
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Types of femoral bone fractures
Neck fracture
Inter-trochanteric
Sub-trochanteric #
Shaft fractures
F. Neck fracture
GeneralFacts
Causes Treatment Complication
F. Neck fracture
GeneralFacts
Causes Treatment Complication
Garden classification
incomplete
Impacted in valgus
complete # with partial D.
complete with full displacement
F. Neck fracture
GeneralFacts
Causes Treatment Complication
Garden classification
Classification According to
site of # subcapital
Transcervical
basicervical
F. Neck fracture
GeneralFacts
Causes Treatment Complication
Garden classification
Classification According to
site of #
subcapital Transcervical basicervical
F. Neck fracture
GeneralFacts
Causes Treatment Complication
Garden classification
Classification According to
site of #
Missing F neck
Fractures ?
Femoral neck # can be missed in 4 groups
stress # in Elderly Patients
Non-displaced #
painless ( silent ) #
multiple #s
X
F. Neck fracture
GeneralFacts
Causes Treatment Complication
Garden classification
Classification According to
site of #
Missing F neck
Fractures ?
Radiologic investigation
X-ray
MRI Bone scan
If normal but clinical suspicion of a hip # remains high
F. Neck fracture
GeneralFacts
Causes Treatment Complication
Elderly simple falls
Young high-energy
injuries
falls into greater
trochanter
[as fall from height or RTA
F. Neck fracture
GeneralFacts
Causes Treatment Complication
Elderly Young
All patients require surgery if fit for an operation
Internal F. with lag multiple 3-4 screws or pins placed in
parallel fashion
Better to have prosthetic replacement
F. Neck fracture
GeneralFacts
Causes Treatment Complication
If young
with
Displaced #
Emergent surgery[close or open reduction
+ internal Fixation]
To prevent
Osteonecrosis
F. Neck fracture
GeneralFacts
Causes Treatment Complication
Nonunion Osteonecrosis Healing
inhibition
↑ with displacement
& older
↑ with displacement & intracapsular
hematoma
by Synovial fluids or Angiogenic-
inhibiting factors
F. Shaft fracture
Causes Treatment Complication
F. Shaft fracture
Causes Treatment Complication
If Elderly
Always Suspect pathological fracture until proven otherwise
Young high-energy
injuries
F. Shaft fracture
Causes ComplicationTreatment
Treatment if with neck #
or vascular injury
Open reduction + plating
if child + have anesthesia problems + inability to
do IF
Traction & bracing
Method of choice
Intramedullary nailingas controls rotation & stabilize distal third #
if multiple or severe open injuries , severe Bn loss
or adolescents
External fixation
Treatment
• Method of choice• Intramedullary nailing as controls rotation & stabilize
distal third #• if with neck # or vascular injury• Open reduction + plating • if child + have anesthesia problems + inability to do IF• Traction & bracing • if multiple or severe open injuries , severe Bn loss or
adolescents• External fixation
Method of choice
Intramedullary nailingas controls rotation & stabilize distal third #
F. Shaft fracture
Causes ComplicationTreatment
1
if with neck # or VI
Open reduction + plating
F. Shaft fracture
Causes ComplicationTreatment
2
if child + have anesthesia problems + inability to do IF
Traction & bracing
F. Shaft fracture
Causes ComplicationTreatment
3
if multiple or severe open injuries , severe Bn loss or adolescents
External fixation
F. Shaft fracture
Causes ComplicationTreatment
4
F. Shaft fracture
Causes ComplicationTreatment
1.Vascular injury.2.Thromboembolism3.Infection 4.Delayed union & non-union5.Malunion 6.Joint Stiffness