Fracture neck femur
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Intra capsular fracture of femur neck
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Fracture neck femur
- 1. 3/5/2013 1
- 2. • Anatomy of Hip Joint • Fracture femur neck Aetiology Mechanism of Injury Classification Clinical features Investigations Treatment 4/17/2014 2
- 3. HIP JOINT • Articular Capsule • Iliofemoral ligament • Pubofemoral ligament • Ischiofemoral ligamnet 4/17/2014 3 Ligaments :
- 4. 4/17/2014 4 Principal compressive group Ward’s triangle
- 5. 4/17/2014 5 Blood supply: Femoral artery Profunda femoris artery Lateral circumflex arteryMedial circumflex artery EXTRACAPSULAR ARTERIAL RING EXTRA CAPSULAR ARTERIAL RING Retinacular arteries SUBSYNOVIAL INTRACAPSULAR ARTERIAL RING Epiphyseal branchesMetaphyseal branches Artery of ligament teres
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- 8. • Older patients – Osteoporosis or Osteomalacia • Elderly women • Major trauma in young adults like RTA,fall etc. 4/17/2014 8 AETIOLO
- 9. • Trivial fall – direct blow over the greater trochanter • Lateral rotation of the extremity posterior communition of the neck. • Cyclical loading due to muscle force and torsion 4/17/2014 9
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- 15. 4/17/2014 15 Prerequisites : Traction Internal rotation
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- 22. 4/17/2014 22 It is the line drawn from the superior margin of the obturator foramen to the margin of neck.
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- 24. 4/17/2014 24 •Oxygen tension measurement •Venography •Intraosseous pressure recording •Isotope scanning •Bone scan with Tc-99m, sulphur colloid, etc.
- 25. 4/17/2014 25 • Early anatomical reduction – prevents further vascular damage. • Impaction of fracture fragments • Rigid internal fixation: enables the vascularization from the surrounding soft tissues and uninjured bones – early callus formation.
- 26. 4/17/2014 26 Fracture neck of femur Undisplaced Displaced Physiologically <60 years Physiologically >60 years Closed reduction under x-ray control Prosthetic replacement Reduction possible Reduction not possible Normal hip Hip with pre existing arthritis Multiple screw fixation Open reduction screw fixation hemiarthroplasty THR Conservative Multiple screws
- 27. 4/17/2014 27 Garden I: Conservative Hip Spica for -old fracture. -unfit for surgery. surgical multiple pins by Moore,Knowles cannulated screws. Garden II: fracture fixed with DHS, multiple cannulated AO screws. Gardens III/IV: conservative treatment rarely indicated. SURGERY – anatomical reduction impaction stable internal fixation Treatment plans as per Garden’s Classification
- 28. 4/17/2014 28 Reduction techniques Closed reduction with hip in extension •Whitman’s method •Massie •Mc Elevenny •Deyerle Closed reduction with hip in flexion •Lead better method •Smith Peterson •Flynn
- 29. 4/17/2014 29 INTERNAL FIXATION for fracture neck of femur Choices of implants for internal fixation: Multiple pins (Knowles,Moore): - - impacted fractures - medically unfit persons - fractures in children. ASNIS: - provide improved pullout and bending and torque strengths.* Fixed angle nail Sliding or Telescopic nails (Dynamic Hip Screws): nail offers collapsibility continuous impaction at the fracture site lessen the chances of nail penetration.
- 31. 4/17/2014 31 Blade plate fixation:
- 32. 4/17/2014 32 Complications of Internal Fixation Infection Nonunion Avascular necrosis Loose fixation
- 33. 4/17/2014 33 Meyer’s Muscle Pedicle Graft:
- 34. 4/17/2014 34 1/3 cases heal with OR+IF Rate – 85-95% * Causes: • Inaccurate reduction • Poor Internal Fixation • Lack of Cambium layer in periosteum. • Avascularity of femoral head • Posterior wall communition Incidece; 40%
- 35. 4/17/2014 35 •Unable to bear weight on affected side •Trendelenberg test +ve •Telescopic test +ve •Wasting of muscles •Minimal shortening of affected limb.
- 36. 4/17/2014 36 Head is viable Head is not viable Osteotomy Acetabular cartilage viable Acetabular cartilage not viable THRHemireplacement arthroplasty Bipolar arthroplasty
- 37. 4/17/2014 37 Due to actual AVN: 2˚ to ischemia Late segmental collapse: due to collapse of subchondral and articular cartilage. INCIDENCE: Aseptic necrosis: 66-84% Late segmental collapse: 7-27% Survival of head depends upon: • Uninjured vascular supply • Revascularization
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- 39. 4/17/2014 39 Radiography Bonescan •Symptomatic treatement: bed rest, NSAIDS. •Displacement or Angulation Osteotomy in early stages. •Hemireplacement arthroplasty •THR.
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- 45. 4/17/2014 45 •An unsolved problem •Fracture in elderly •Majority due to trivial fall. •Garden’s classificatio is widely accepted. •It is an Orthopaedic Emergency. •Speed is the watchword in management. •Early anatomical reduction,impaction and rigid internal fixation are the aim of treatment. •DHS and Multiple cannulated cancellous screws is the currently accepted method of fixation. •Nonunion ad AVN are very common.
- 46. 4/17/2014 46