CLASSIFICATION AND MANAGEMENT

1. FRACTURE NECK OF FEMUR
PRESENTER : DR. BINAY KUMAR SAHU
CENTRAL INSTITUTE OF ORTHOPAEDICS
VMMC AND SAFDARJUNG HOSPITAL

2. INTRODUCTION
• PROXIMAL FEMUR PHYSIS CONTRIBUTES 15% OF THE LIMB
GROWTH
• SINGLE PHYSIS AT BIRTH WHICH DIVIDES INTO TWO
1. CAPITAL EPIPHYSIS : OSSIFICATION CENTRE AT 4-6 MONTHS ~
CLOSES AT 18YR
2. TROCHANTERIC APOPHYSIS: OSSIFCATION CENTRE AT 4YR ~
CLOSES AT 16-18YR
• NECK-SHAFT ANGLE- 135° AT BIRTH › 145°AT 1-3YR › 130+/-7° AT
SKELETAL MATURITY
• FEMORAL ANTEVERSION- 40° AT INFANCY › 15-25° AT MATURITY
• AVERAGE ADULT LENGTH OF FEMUR NECK IS AROUND 3.7 CM

3. BLOOD SUPPLY
• THREE SETS OF BLOOD VESSELS
• CAPSULAR VESSELS: MEDIAL CIRCUMFLEX (MAJOR SUPPLY) AND
LATERAL CIRCUMFLEX FEMORAL ARTERY FORM
EXTRACAPSULAR CIRCULAR ARTERIAL ANASTOMOSIS AT FEMUR
NECK BASE -› GIVE RISE TO ASCENDING CERVICAL CAPSULAR
ARTERIES WHICH PENETRATE CAPSULE AND ARE CALLED
RETINACULAR VESSELS -› 4 GROUPS OUT OF WHICH LATERAL GR
IS LARGEST CONTRIBUTOR TO HEAD -› THESE FORM
SUBSYNOVIAL INTRAARTICULAR RING AT THE BASE OF FEMORAL
HEAD
• THE ARTERY OF LIGAMENTUM TERES -› BR OF OBTUTAROR
ARTERY OR SOMETIMES MED. CIRCUMFLEX FEMORAL ARTERY
• BLOOD SUPPLY BY MEDULLARY VESSELS/ ENDOSTEAL SUPPLY

5. BLOOD SUPPLY BEFORE MATURITY
• AT BIRTH BOTH MED. & LAT. CIRCUMFLEX FEMORAL ARTERIES
SUPPLY THE HEAD
• THE FOVEAL ARTERY SUPPLIES ONLY SMALL AREA OF MEDIAL
HEAD
• BLOOD VESSELS WHICH CROSS PHYSIS AT BIRTH DISSAPEAR BY
15-18 MONTHS
• BY AGE OF 3 YR – CONTRIBUTION OF LAT. CIRCUMFLEX FOMORAL
ARTERY DIMINISHES AND ENTIRE BLOOD SUPPLY COMES FROM
MED. CIRCUMFLEX ARTERY. THIS ARRANGEMENT PERSISTS IN
ADULTS
• BY 8 YR THE FOVEAL ARTERY PROVIDES 20% OF BLOOD TO
FEMUR HEAD AND MAINTAINS IT INTO ADULTHOOD

6. TRABECULAR PATTERN IN PROXIMAL FEMUR
• TWO PRINCIPAL GROUPS
• TENSILE
• COMPRESSILE
• TWO SECONDARY GROUPS
• TENSILE
• COMPRESSILE
• GREATER TROCHANTER GROUP

8. EPIDEMIOLOGY
• INTRACAPSULAR NECK # CONSTITUTES 50% OF ALL HIP #
• MOST COMMONLY SEEN IN ELDERLY (6/7th DECADE) MAINLY
DUE TO MINOR FALL OR TRIVIAL TRAUMA
• YOUNG ADULTS CAN GET # NECK IN HIGH VELOCITY TRAUMA
WHICH IS COMMONLY ASSOCIATED WITH OTHRER INJURIES

9. RISK FACTORS
• FEMALE SEX (POST MENOPAUSAL)
• WHITES
• OLD AGE
• WEIGHT
• OSTEOMALACIA
• ALCOHOLIC
• DIABETES
• CHRONIC DISEASE / BED-RIDDEN

10. • DRUGS
• PPI
• ANTI-PSYCHOTIS
• CORTICOSTERIODS
• GnRH

11. CLASSIFICATION
• ACCORDING TO CAUSE
• STRESS #
• PATHOLOGICAL #
• TRAUMATIC #
• POST IRRADIATION #

12. ACCORDING TO ANATOMIC LOCATION
• INTRACAPSULAR
• SUBCAPITAL
• TRANSCERVICAL
• BASICERVICAL
• EXTRACAPSULAR

13. PAUWEL’S CLASSIFICATION : ANGLE BETWEEN # LINE
AND THE HORIZONTAL
• TYPE 1: ANGLE OF 30°
• TYPE 2: ANGLE OF 30-50°
• TYPE 3: ANGLE OF >50°
• AS THE FRACTURE PROGRESSES FROM TYPE 1 TO TYPE 3, THE OBLIQUITY
OF THE FRACTURE LINE INCREASES, THUS THE SHEAR FORCE AT THE
FRACTURE SITE INCREASES. THIS RESULTS IN INCREASING #
INSTABILITY WITH MORE COMPLICATIONS OF FRACTURE HEALING AND
FIXATION.

14. GARDEN CLASSIFICATION : BASED ON DEGREE OF
DISPLACEMENT ON AP RADIOGRAPH BY DETERMINIG THE
RELATIONSHIP OF THE TRABECULAR LINES IN THE FEMORAL
HEAD TO THOSE OF ACETABULUM
• TYPE 1 : VALGUS IMPACTED INCOMPLETE #. TRABECULAR
LINES IN THE HEAD FORM AN ANGLE WITH THOSE OF
ACETABULUM
• TYPE 2 : # IS COMPLETE BUT UNDISPLACED. TRABECULAE IN
HEAD ARE ALINGNED WIITH THAT OF ACETABULUM AND
NECK
• TYPE 3 : COMPLETE # WITH PARTIAL DISPLACEMENT. HEAD
IS IN VARUS AND EXTENDED RESULTING IN ANGULATION OF
ALL THREE TRABECULAR LINES.
• TYPE 4 : # IS COMPLETELY DISPLACED. TRABECULAR LINES
OF HEAD AND ACETABULUM ARE COLINEAR BUT THAT OF

16. AO/OTA CLASSIFICATION
NECK FEMUR IS 31B
• B1 group fracture is nondisplaced to minimally displaced
subcapital fracture
• B2 group includes transcervical fractures through the
middle or base of the neck
• B3 group includes all displaced nonimpacted subcapital
fractures

18. PAEDIATRIC NECK FEMUR # (PROXIMAL FEMUR)
DELBET’S CLASSIFICATION
• TYPE 1: TRANSEPIPHYSEAL
• 1A : HEAD WITHIN ACETABULUM
• I B : HEAD OUTSIDE ACETABULUM
• TYPE 2 : TRANSCERVICAL
• TYPE 3 : CERVICOTRONCHANTERIC
• TYPE 4: PERTROCHANTERIC

20. CLINICAL FEATURES
• H/O MINOR FALL IS USUALLY PRESENT IN ELDERLY
• IN CASE OF STRESS OR IMPACTED # PATIENT GENERALLY
COMPLAINS OF MILD ANT. HIP PAIN OR REFFERED ALONG
MEDIAL SIDE OF THIGH AND KNEE. PATIENT CAN EVEN COME
WALKING WITH ANTALGIC GAIT
• IN CASE OF DISPLACED # PATIENT IS NON AMBULATORY WITH
MODERATE-SEVERE PAIN AT THE HIP JOINT ALONG WITH
SHORTENING AND EXTERNAL ROTATION OF THE EXTREMITY
• ACTIVE SLR NOT POSSIBLE
• TENDERNESS CAN BE ELICITATED AT SCARPA’S TRIANGLE

21. • DISTAL FRAGMENT IS EXTERNALLY ROTATED ,
ADDUCTED AND PROXIMALLY MIGRATED
• THIS IS MAINLY DUE TO GLUTEUS MAXIMUS, SHORT
EXT. ROTATORS AND ADDUCTORS
• EXTERNAL ROTATION IS LESS MARKED AS COMPARED
TO #I/T DUE TO CAPSULAR ATTACHMENT WHICH
PREVENTS DOING SO OF THE DISTAL FRAGMENT.

22. RADIOGRAPHY
• EXTENT OF # : COMPLETE/INCOMPLETE
• # ANGLE
• BREAK IN SHENTON LINE
• POSTERIOR WALL COMMINUTION
• OSTEOPOROSIS

23. SHENTON LINE:
SHENTON'S LINE IS A LINE FORMED BY THE INFERIOR
ASPECT OF THE SUPERIOR PUBIC RAMUS AND THE
MEDIAL ASPECT OF THE UPPER FEMUR. SHENTON'S
LINE SHOULD DESCRIBE A SMOOTH CURVE.
BROKEN IN NECK #

24. • X-RAY AP VIEW PELVIS
• LATERAL VIEW OF THE HIP
• FULL THIGH AP AND LATERAL ALSO SHOULD BE OBTAINED
• TRACTION AND INTERNAL ROTATION AP VIEW PELVIS IS THE
BEST VIEW TO DEFINE FRACTURE LINE

25. CT SCAN
• USEFUL IN EVALUATING COMMUNITION PREOPERATIVELY
• ABNORMALITIES OF BONE IN PATHOLOGICAL #
• TO CHECK FOR UNION POSTOPERATIVELY
MRI
• USEFUL TO RULE OCCULT FRACTURE LIKE STRESS #
• BUT IS NOT READILY AVAILABLE AND EXPENSIVE
BONE SCAN
• SHOWS INCREASED UPTAKE : 80% # SHOW AFTER 24 HR ; 95% AT 7
DAYS
BONE SCAN

26. TREATMENT
• ACCORDING TO SANDHU
I. FRESH # ( 1-21 DAYS)
• AGE 1-16YRS :PHYSIS OPEN AND IMPLANT SHOULD
CAUSE MINIMUM DAMAGE
• UNDISPLACED : INTERNAL FIXATION WITH 2-2.5mm
K-WIRE or MOORE’S PINS
• DISPLACED : CLOSED REDUCTION AND INTERNAL
FIXATION K-WIRES/MOORE’S PINS
(FOR BASAL # CANNULATED SCREWS 4mm CAN ALSO
BE USED)

27. • IF CLOSED REDUCTION FAILS THEN OPEN
REDUCTION AND INTERNAL FIXATION SHOULD BE
DONE
• ALTERNATIVELY –
• McMURRAYS OSTEOTOMY WITH HIP SPICA
• ABDUCTION OSTEOTOMY WIYH INTERNAL
FIXATION WITH PAEDIATRIC DHS / 135°
PAEDIATRIC BLADE PLATE

28. • AGE 16-50YRS
1. SUBCAPITAL #
• UNDISPLACED : INT. FIXATION WITH 2-3
CANNULATED SCREWS
• DISPLACED : CLOSED REDUCTION AND INT. FIXATION
WITH CANNULATED SCREWS
OTHER OPTIONS: 1. ABDUCTION OSTEOTOMY WITH
135° BLADE PLATE/ DOUBLE ANGLE BLADE PLATE /
MODIFIED DHS
2. CLOSED REDUCTION AND INT. FIXATION WITH 2
CCS AND ONE FREE FIBULAR GRAFT

29. 2. TRANSCERVICAL #
• UNDISPLACED # : INT. FIXATION WITH CCS
• DISPLACED # : CLOSED REDUCTION AND INT.
FIXATION WITH CCS
IF CR FAILS THEN :
• ORIF WITH CCS
• ORIF WITH CCS AND FREE FIBULAR GRAFT /
MUSCLE PEDICLE GRAFT

30. 3. BASAL #
• UNDISPLACED : INT. FIXATION WITH DHS
• DISPLACED : CRIF WITH CCS / DHS
IF CR FAILS THEN ORIF WITH/ / DHS

31. AGE : 50-60YRS
1. SUBCAPITAL #
• UNDISPLACED : INT. FIXATION WITH CCS
• DISPLACED :
• CRIF WITH CCS
• CRIF WITH CCS AND FREE FIBULAR GRAFT
• ABDUCTION OSTEOTOMY
• REPLACEMENT ARTHROPLASTY : BIPOLAR / THR
IF CR FAILS THEN
• ORIF WITH CCS AND FREE FIBULAR GRAFT
• REPLACEMENT ARTHROPLASTY

32. 2. TRANSCERVICAL FRACTURE
• UNDISPLACED : INT. FIXATION WITH CCS
• DISPLACED : CRIF WITH CCS +/- FIBULAR GRAFT
IF CR FAILS THEN
• ORIF WITH CCS AND FREE FIBULAR GRAFT / BONE
MUSCLE PEDICLE GRAFT
• REPLACEMENT ARTHROPLASTY

33. 3. BASAL FRACTURE
• UNDISPLACED : INT. FIXATION WITH CCS OR DHS
• DISPLACED : CRIF WITH CCS / DHS / 135º BLADE
PLATE
IF CLOSED REDUCTION FAILS
• ORIF WITH CCS / DHS / 135º BLADE PLATE
• REPLACEMENT ARTHROPLASTY

34. AGE ABOVE 60YRS
1. SUB CAPITAL #
• UNDISPLACED :
• INT. FIXATION WITH CCS
• REPLACEMENT ARTHROPLASTY
• DISPLACED :
• REPLACEMENT ARTHROPLASTY IS THE CHOICE
• CRIF WITH CCS AND FREE FIBULAR GRAFT CAN
BE TRIED
IF CR FAILS THEN REPLACEMENT ARTHROPLASTY

35. 2. TRANSCERVICAL
• UNDISPLACED :
• INT. FIXATION WITH CCS
• REPLACEMENT ARTHROPLASTY
• DISPLACED
• REPLACEMENT ARTHROPLASTY IS CHOICE
• CRIF WITH CCS CAN BE TRIED
IF CR FAILS THEN REPLACEMENT ARTHROPLASTY

36. 3. BASAL #
• UNDISPLACED:
• INT. FIXATION WITH CCS OR DHS
• DISPLACED #
• CRIF WITH CCS OR DHS
IF CR FAILS THEN REPLACEMENT ARTHROPLASTY
IS THE CHOICE

37. CONSERVATIVE TREATMENT
• RESERVED FOR CRITICALLY ILL PATIENTS WITH
UNDISPLACED# WHO ARE UNFIT FOR SURGERY AND
ANAESTHESIA
• PATIENTS ARE KEPT ON BED REST
• FRACTURE CAN BE EXPECTED TO HEAL IN 4-6 WEEKS
• SIGNIFICANT RISK OF DISPLACEMENT

38. II. # DURATION MORE THAN 3 WEEKS
AGE 1-16 YRS
• Mc MURRAY’S OSTEOTOMY AND HIP SPICA
• ABDUCTION OSTEOTOMY AND INT. FIXATION WITH
135º PAEDIATRIC BLADE PLATE / PAEDIATRIC DHS
• CRIF / ORIF WITH A CCS AND FREE FIBULAR GRAFT –
SHOULD BE AVOIVED AS INCREASED CHANCE OF
INJURY TO PHYSIS

39. AGE 16- 55 YRS
HIP JT. SHOULD BE PRESERVED WITH OSTEOSYNTHEIS AND UNION AS AIM
BUT VARIOUS CHANGES WOULD HAVE TAKEN PLACE WITH TIME
• STAGE I
1. # SURFACES IRREGULAR
2. PXOXIMAL FRAGMENT SIZE 2.5 CM OR MORE
3. GAP 1 CM OR LESS
4. HEAD VIABLE
• STAGE II
1. # SURFACES SMOOTH
2. PROXIMAL FRAGMENT SIZE 2.5 CM OR MORE
3. GAP MORE THAN 1 CM BUT LESS THAN 2.5 CM
4. HEAD VIABLE
EITHER 1 OR 3 SHOULD BE PRESENT

40. • STAGE III
1. # SURFACES SMOOTH
2. PROXIMAL FRAGMENT SIZE LESS THAN 2.5 CM
3. GAP MORE THAN 2.5 CM
4. HEAD SHOWS SIGN OF AVN
EITHER 2 , 3 , 4 SHOULD BE PRESENT

41. • TREATMENT OF STAGE I
SUCCESS OF OSTEOSYNTHESIS HIGH
• CRIF WITH 2 CCS + 1 FIBULAR GRAFT
• CRIF WITH 1 CCS + 2 FIBULAR GRAFT
• CRIF / ORIF WITH CCS AND MUSCLE PEDICLE GRAFT
• ABDUCTION OSTEOTOMY – USEFUL WHEN LENGTH OF
PROXIMAL SEGMENT IS 3.5 CM OR MORE AND # IS TOWARDS
BASE
• Mc MURRAY’S OSTEOTOMY WITH HIP SPICA

42. TREATMENT OF STAGE II
OSTEOSYNTHESIS HAS GOOD RESULTS
• CRIF WITH 2 CCS+ 1 FIBULAR GRAFT
• CRIF WITH 1 CCS + 2 FIBULAR GRAFT
• ORIF WITH FRESHENING OF # SITE WITH 2 CCS+ ONE FIBULA GRAFT
• ORIF WITH FRESHENING OF # SITE WITH 3 CCS+ MUSCLE PEDICLE
GRAFT
• OTHERS METHODS THAT CAN BE USED IN DEVELOPING NATIONS
• Mc MURRAY’S OSTEOTOMY
• ABDUCTION OSTEOTOMY
• GIRDLESTONE PROCEDURE

43. TREATMENT OF STAGE III
OSTEOSYNTHESIS HAS HIGH FAILURE RATE
• TOTAL HIP ARTHROPLASTY
• BIPOLAR / UNIPOLAR ARTHROPLASTY
• SUBTROCANTERIC OSTEOTOMY WITH INTERNAL
FIXATION
• GIRDLESTONE PROCEDURE
• PATIENT CAN BE LEFT ALONE IF HE IS NON COMPLIANT /
POOR/ UNFIT

44. AFTER AGE OF 55 YRS
• REPLACEMENT ARTHROPLASTY
• OSTEOSYNTHESIS – IF PATIENT WANTS IT AND DONE
ONLY IN STAGES I & II
• GIRDLESTONE PROCEDURE
• OSTEOTOMY
• LEAVE HIM ALONE

45. FINALLY , THE DECISION REGARDING OPERATIVE PROCEDURE
RESTS WITH THE SURGEON DEPENDING UPON
• PATIENTS LIFESYTLE
• REQUIREMENTS
• PROFESSION
• FINANCIAL POSITION
IF PATIENT IS SUFFERING FROM CHRONIC DISEASE LIKE DIABETES
, HEART FAILURE, CRF, LIVER DISEASE, MALIGNANCY ETC. OR IS
TAKING STEROIDS THEN REPLACEMENT ARTHROPLASTY CAN BE
CONSIDERED EVEN IN YOUNG AGE

46. OPERATIVE TREATMENT
FOR UNDISPLACED NECK FRACTURES
FIXATION IS THE TREATMENT OF CHOICE AT ALL AGE
GROUPS EXCLUDING CHILDREN
THE USUAL CHOICE IS 6.5MM CANNULATED SCREWS: 3
SCREWS
SLIDING HIP SCREW WITH A SHORT PLATE CAN ALSO BE
CONSIDERED BUT ARE ASSOSIATED WITH MORE INVASIVE
PROCEDURE AND BLOOD LOSS
OUTCOMES
ABOUT 7% NONUNION
4-22% AVN OF FEMORAL HEAD

47. REDUCTION TECHNIQUES
WHITMAN DESCRIBED A METHOD IN WHICH PATIENT
IS LAID SUPINE IN FRACTURE TABLE AND TRACTION IS
APPLIED ON THE LIMB IN EXTENSION AND ABDUCTION
AND THEN INTERNALLY ROTATED
LEADBETTER DESCRIBED A METHOD IN WHICH LIMB IS
FLEXED AT HIP 90° AND THIGH IS INTERNALLY ROTATED
WITH TRACTION APPLIED IN LINE WITH FEMUR. THE
LIMB IS CIRCUMDUCTED INTO ABDUCTION
MAINTAINING INT. ROTATION AND IS BROUGHT DOWN
TO TABBLE IN EXTENSION

48. EVALUATION OF REDUCTION
REDUCTION SHOULD BE JUDGED ON AP AND LATERAL VIEWS
THE JUNCTION OF THE CONVEX FEMORAL HEAD AND NECK
SHOULD PRODUCE AN S-SHAPED CURVE IN ALL PLANES
ON AP VIEW, A VALGUS REDUCTION REDUCTION IS PREFERABLE
TO A VARUS REDUCTION AS VALGUS IS MORE STABLE AND VARUS
IS ASSOCIATED WITH A MUCH HIGHER RISK OF FIXATION
FAILURE

49. GARDEN ALINGMENT INDEX : TO MEASURE THE QUALITY OF
REDUCTION BASED ON BONY TRABECULAR ALINGMENT. ON AP VIEW
THE ANGLE BETWEEN THE CENTRAL AXIS OF MEDIAL TRABECULAR
SYSTEM IN THE HEAD AND THE MEDIAL CORTEX SHOULD NORMALLY
BE 160°. ON LATERAL VIEW THE CENTRAL TRABECULAR AXIS IS IN
LINE WITH THE FEMORAL HEAD AT 180°
ANGLE BETWEEN 155-180° IN EITHER VIEW IS CONSIDERED GOOD
FIXATION

50. POSITION OF CANNULATED SCREWS

51. SPECIAL CONDITIONS
• I/L FEMUR SHAFT AND NECK #
• ANTEGRADE FEMUR NAILING WITH SIMULTANEOUS
FIXATION OF NECK- PFN
• CCS FOR NECK + RETROGRADE NAIL FOR SHAFT #
• CCS FOR NECK + PLATING FOR SHAFT #
• FIXATION WITH DHS WITH LONG SIDE PLATE

52. • WITH RHEMATOID ARTHRITIS
OSTEOPOSIS IS A FEATURE
• IF UNDISPLACED AND YOUNG :
• INT. FIXATION WITH CCS +/- FIBULAR GRAFT
• SATISFACTORY RESULTS ARE OBTAINED WITH
REPLACEMENT ARTHROPLASTY
• STRESS #
• INTERNAL FIXATION AS FRAGMENTS TEND TO
DISPLACE

53. • PAGET’S DISEASE
BONE IS VERY VASCULAR / SCLEROTIC
INCREASED RISK OF COXA VARA
• THR IS PREFERED AS ACETABULUM IS COMMONLY
INVOLVED
• METASTATIC NECK #
PRE-OP EVALUATION
• REPLACEMENT ARTHROPLASTY IS CHOICE
DEPENDING ON LIFE EXPECTANCY

54. COMPLICATIONS IN ADULT
• FAILURE OF FIXATION
CAUSES :
• INADEQUATE REDUCTION
• POOR IMPLANT SELECTION
• NON UNION / AVN
• INFECTION
TREATMENT
• IN YOUNG ADULTS: REVISION SURGERY FOR
OSTEOSYNTHESIS
• IN ELDERLY : REPLACEMENT ARTHROPLASTY

55. • NON UNION AND AVN OF HEAD
ABOUT 9% AND 23% RESPECTIVELY
LIKELY CAUSES :
• PATTERN OF BLOOD SUPPLY
• SYNOVIAL FLUID CAUSING TAMPONADE EFFECT
• ABSENCE OF THE CAMBIUM LAYER OF
PERIOSTEUM IN NECK FEMUR

57. TREATMENT OF AVN
• CORE DECOMPRESSION
• INCREASES VASCULARITY BY DECREASING
INTRAOSSEUS PRESSURE
• SLOWS PROGRESSION OF DISEASE
• DONE IN FICAT STAGE I & IIA
• CORE DECOMPRESSION + BONE GRAFTING
• CORTICAL / CANCELLOUS / VASCULARISED
• DONE IN FICAT STAGE I & II

58. • PROXIMAL FEMUR OSTEOTOMY
• MOVE THE INVOLVED NECROTIC HEAD AWAY
FROM WEIGHT BEARING ZONE
• DONE WHEN INVOLVEMENT OF HEAD < 30%
• YOUNG PATIENTS HAVE SHOWN BETTER RESULTS
• VALGUS EXTENDED INTER-TRONCHANTERIC
OSTEOTOMY + CURRETAGE AND BONE GRAFTING
• RESURFACING HEMIARTHROPLASTY
• BIPOLAR / THR

59. COMPLICATIONS CONTD.
• INFECTION
• DVT
• DISLOCATION OF PROSTHESIS
• UNOPOLAR – 2%
• BIPOLAR – 3%
• THR – 6-8%
• PROSTHESIS LOOSENING

60. COMPLICATIONS IN PAEDIATRIC NECK#
• AVN : MAXIMUM IN TYPE 1 TRANSEPIPHYSEAL
• TYPE I : 40-100%
• TYPE 2 : 28-50%
• TYPE 3: 18-25%
• TYPE 4 : 5-15%
• COXA VARA: 10-32% . CAUSES:
• MALREDUCTION
• INADEQUATE STABILIZATION
• DELAYED UNION/ NONUNION
• PRE MATURE CLOSURE OF PHYSIS

61. • NON UNION : 6.5-12.5%
• PRE MATURE PHYSEAL ARREST : 10-62%
• INFECTION : 1%

62. THANK YOU