fracture neck of femur and trochanteric fracture

hip fractures require special attention

1. FRACTURE OF THE NECK OF FRACTURE OF THE NECK OF
FEMURFEMUR

2. INTRODUCTIONINTRODUCTION
 The hip is a stable The hip is a stable
joint.joint.
Most fractures are the Most fractures are the
result of indirect force.result of indirect force.

3. Anatomical factorsAnatomical factors
Blood supply to the head & neck of Blood supply to the head & neck of
femur.femur.
Incidence & mechanism.Incidence & mechanism.
Why is it always little old ladies who fracture Why is it always little old ladies who fracture
their femoral neck?their femoral neck?

5. Fractures of the femoral neckFractures of the femoral neck
Intracapsular fracturesIntracapsular fractures

Extracapsular fracturesExtracapsular fractures..

6. CLINICAL PICTURECLINICAL PICTURE
History.History.
Symptoms.Symptoms.
Signs.Signs.
Deformity.Deformity.
RADIOGRAPHYRADIOGRAPHY

9. INTRACAPSULAR FRACTURESINTRACAPSULAR FRACTURES
Classification (GARDEN):Classification (GARDEN):
Stage 1: incomplete fracture of the neckStage 1: incomplete fracture of the neck
Stage 2: complete without displacement.Stage 2: complete without displacement.
Stage 3: complete with partial displacement.Stage 3: complete with partial displacement.
Stage 4: complete femoral neck fracture with Stage 4: complete femoral neck fracture with
full displacement.full displacement.

10. Garden type IGarden type I

11. Garden typeIIGarden typeII

12. Garden type IIIGarden type III

13. Garden type IVGarden type IV

14. MANAGEMENTMANAGEMENT
SURGICAL TREATMENT:SURGICAL TREATMENT:
Perfect open anatomical reduction.Perfect open anatomical reduction.
Rigid internal fixation:Rigid internal fixation:
1) Three-flanged Smith-1) Three-flanged Smith-
Petersen nail & parallel screw.Petersen nail & parallel screw.
2) Dynamic Hip Screw.2) Dynamic Hip Screw.

15. Treatment, Garden I-II: PinsTreatment, Garden I-II: Pins

16. Hemiarthroplasty Hemiarthroplasty
(Austin Moore’s (Austin Moore’s
prosthesis).prosthesis).
Total Hip Total Hip
Replacement.Replacement.
Excision Excision
arthroplasty arthroplasty
(Girdlestone (Girdlestone
pseudarthrosis)pseudarthrosis)

19. COMPLICATIONSCOMPLICATIONS
Avascular necrosis of head of femur.Avascular necrosis of head of femur.
Non-union.Non-union.
DVT, bed sores, UTI & pneumonia.DVT, bed sores, UTI & pneumonia.
Osteoarthritis.Osteoarthritis.

20. EXTRACAPSULAR EXTRACAPSULAR
FRACTURESFRACTURES
Stable.Stable.
Unstable.Unstable.
CLINICAL FEATURESCLINICAL FEATURES
external rotation & shortening.external rotation & shortening.
Swelling & ecchymoses.Swelling & ecchymoses.

21. RADIOLOGICAL FEATURES:RADIOLOGICAL FEATURES:
oStable Type:Stable Type:
single fracture line. single fracture line.
two peace fracture.two peace fracture.
oUnstable Type:Unstable Type:
comminuted fracture.comminuted fracture.
multiple fractures. multiple fractures.

24. MANAGEMENTMANAGEMENT
Open reduction & internal fixation: Open reduction & internal fixation:
DHS.DHS.
Ender’s nails.Ender’s nails.
Intramedullary devises.Intramedullary devises.
Continuous traction.Continuous traction.
Plaster spica or plastic splint.Plaster spica or plastic splint.

25. COMPLICATONSCOMPLICATONS
Failure of fixation device.Failure of fixation device.
Malunion (coxa vara).Malunion (coxa vara).
Osteoarthritis.Osteoarthritis.
Joint stiffness.Joint stiffness.
Complications of immobilization & Complications of immobilization &
recumbence.recumbence.

26.                                                      

Intracapsular                                    
Extracapsular

       

Incidence                               
Less common                                  More common
       
Causative violence                  Minimal rotation violence                  Lateral violence
Clinical
features
       
External rotation                     Minimal                                            Fully externally
rotated

       
Local swelling                         Nil                                                   Marked local
swelling

       
Treatment                               Difficult                                            Easy
Complications

       
Non Union                             Common                                          Does not occur
       
Malunion                                Rare                                                Common

27. Subtrochanteric fracture…..Subtrochanteric fracture…..
intramedullary rod fixation is the choice of treatment intramedullary rod fixation is the choice of treatment

28. THANK YOU