After completion of this session, students should be able to discuss, identify, and describe: The anatomical factors predisposing to the etiology of a fracture or dislocation. The anatomy of displacement or deformity. Imaging anatomy features and how to differentiate from epiphyseal lines. Anatomy related to correct relocation and alignment. Anatomical complications of a fracture or dislocation.

1. Dr.AkramJaffar
Imaging Anatomy of Fractures and Dislocations inImaging Anatomy of Fractures and Dislocations in
the Lower Limbthe Lower Limb
Fractures of the femurFractures of the femur
Akram Jaffar, Ph.D.
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2. Dr.AkramJaffar
References and suggested reading
• Ellis H (2006): Clinical anatomy, A revision and applied anatomy for clinical students.
11th
Ed. Blackwell Publishing. Massachusetts.
• Moore KL et al. (2013): Clinically Orientated Anatomy. 7th Ed. Lippincott, Williams &
Wilkins. Philadelphia.
• Hamblen DL & Simpson HRW (2007): Adam’s outline of fractures including joint
injuries. 12th
ed. Churchill Livingstone Elsevier. Edinburgh.
• Solomon L, Warwick DJ & Nayagam S (2001): Apley's System of Orthopedics and
Fractures. 8th ed. Arnold Publishing.

3. Dr.AkramJaffar
Objectives
After completion of this session, students should be able to discuss, identify, and
describe:
• The anatomical factors predisposing to the etiology of a fracture or dislocation.
• The anatomy of displacement or deformity.
• Imaging anatomy features and how to differentiate from epiphyseal lines.
• Anatomy related to correct relocation and alignment.
• Anatomical complications of a fracture or dislocation.

4. Dr.AkramJaffar
Fracture of the neck of the femur
• Occurs in elderly women and is
usually produced by a minor trip
causing an indirect violence to
the femur.
• Anatomy of the deformity:
• Lateral rotation: short muscles in
the gluteal region i.e. piriformis,
obturator internus and externus,
the gemelli, and quadratus
femoris aided by gluteus
maximus.
• Shortening: pull of muscles
connecting the femur to the
hipbone or lumbar spine (e.g.
sartorius, rectus femoris,
adductors, iliopsoas).

5. Dr.AkramJaffar
Blood supply of the head of the femur
• Derived mostly from the medial and
lateral circumflex femoral arteries
(trochanteric anastomosis).
• Branches from the trochanteric
anastomosis run in the retinacula of
the fibrous capsule along the neck
of the femur to reach the head.
• Blood may also reach the femoral
head through a branch of the
obturator artery that runs in the
ligament of the head of the femur
called the artery of the head of the
femur.
Trochanteric
anastomosis
Retinacular aa.
Artery of the head
Obturator a.

6. Dr.AkramJaffar
Fracture of the neck of the femur
• Anatomical complication:
• Avascular necrosis of the head of the
femur:
– Interruption of the blood supply from
the root of the femoral neck.
– The artery of the ligament of the head
is insufficient alone to supply the head
of the femur; in addition, in old patients
in whom fracture of the neck is likely to
occur, the artery is often not patent
because of atherosclerosis.
– Thus, death of the proximal bone
fragment takes place (avascular
necrosis of the femoral head).
– Replacement of the femoral head and
neck by a prosthesis is recommended.
Retinacular aa.
Artery of the head
Obturator a.
prosthesis
prosthesis

7. Dr.AkramJaffar
Fracture of the neck of the femur
• Anatomical complication:
• Avascular necrosis of the head of the femur:
– Is more likely the more proximal the
fracture to the head (subcapital fracture).
– A subcapital fracture cuts off most of the
retinacular supply to the head.
– A pertrochanteric fracture does not
damage the retinacular supply to the head
Subcapital fracture Intertrochanteric fracture

8. Dr.AkramJaffar
Fracture of the femoral shaft
• May occur in the upper third of the bone.
• Anatomy of displacement:
• The proximal segment is flexed by iliopsoas and
abducted by gluteus medius and minimus.
• The distal segment is pulled medially by the
adductor muscles.
• There is shortening due to spasm of the long strong
surrounding muscles.
Iliopsoas
Gluteus medius & minimus
adductors
Long muscles

9. Dr.AkramJaffar
Supracondylar fracture of the femur
• Anatomy of displacement:
– The distal fragment is tilted
backwards by gastrocnemius which
is attached to it.
• Anatomical complication:
– The sharp proximal edge of the distal
fragment may tear the popliteal
artery that lies directly behind the
popliteal surface of the femur.
• In non-operative management, the
displacement of the distal fragment may
be corrected by flexion of the knee.
gastrocnemius
Popliteal a.
In such a fracture, the pulsations of
which distal artery must be checked?
Flexion of the knee can correct
displacement of distal fragment.

10. Dr.AkramJaffar
Supracondylar fracture of the femur
• Anatomy of displacement:
– The distal fragment is tilted
backwards by gastrocnemius which
is attached to it.
• Anatomical complication:
– The sharp proximal edge of the distal
fragment may tear the popliteal
artery that lies directly behind the
popliteal surface of the femur.
• In non-operative management, the
displacement of the distal fragment may
be corrected by flexion of the knee.
gastrocnemius
Popliteal a.
In such a fracture, the pulsations of
which distal artery must be checked?
Flexion of the knee can correct
displacement of distal fragment.