Neck of femur fractures

Contents

• INTRODUCTION

• ANATOMY

• MECHANISM OF INJURIES

• CLASSIFICATION

• APPROACH TO NECK OF FEMUR FRACTURES

INTRODUCTION

• Neck of femur fractures are more common amongst the elderly patient.

• Risk factors involved in femur fractures are as follow:

1. Osteoporosis

2. Women

3. Low soscioeconomic status

4. Cardiovascular disease

5. medication

ANATOMY

• PLEASE SEE PAGES 478-486 IN ATLAS OF HUMAN ANATOMY

Mechanism of injury

• Falling directly onto the hip

• Twisting mechanism

• Sudden completion if an impartial fracture

• In the young patients it is common after trauma such as MVA and PVA

classification

• The Garden classification is used to classify neck of femur fractures

1. Type1: impaction fracture

2. Type 2: non-displaced fracture

3. Type3: varus displacement of the femoral head

4. Type4: complete loss of the continuity amongst fragments

• Garden classification system of femoral neck fractures. (A) Garden I fracture: incomplete and minimally displaced. The fracture shown is impacted and is in valgus malalignment. (B) Garden II fracture: complete, nondisplaced. (C) Garden III fracture: complete fracture and partially displaced. The fracture shown is in varus malalignment. (D) Garden IV fracture: completely displaced, with no engagement of the 2 principal fragments

Approach to femur fractures

• History

• Co-morbidities

• Cause of the fall

• DVT prophylaxis

• Timing of surgery

Surgery…..

• ORIF VS ARTHROPLASTY

Neck of Femur #

Undisplaced (Garden I-II) Or

Valgus Impaction

Internal Fixation

Displaced (Garden III-IV)

<65 yr oldGood bone qualityNo OA changesStable # pattern

Satisfactory, early reductionStable fixation

Closed reduction +

Cannulated screws

>65yrPoor bonestockOA of hip joint

Unstable fracture patternReduction unobtainable or >1/52

Stable fixation not possible

HealthyActiveYoung

Low risk for dislocationOA/RA Present

THR

Significant comorbid disease

Low demandElderly

High risk for dislocationOA/RA Absent

>5yr life expecta

ncy

Bipo lar Hemi-arthro plasty

<5yr life expecta

ncy

Unip olar He mi-arthro plasty

Non-ambulatoryNon-operable

Relatively painfree

Non-operative

management

COMPLICATIONS

• INFECTIONS

• THROMBOEMBOLISM

• CHRONIC PAIN

• DISLOCATION

• NON-UNION

• AVASCULAR NECROSIS

• POST TRAUMATIC ARTHRITIC CHANGES

RESOURCES

• Atlas of human anatomy(Frank H. Netter)

• Uptodate

• www.google.com

• medscape