This is short presentation of most common fracture in hip joint. Femoral neck fractures are the most common type of fractures around the hip joint- more common in elderly in weak osteoporotic bone. This presentation gives a brief idea about these fractures, investigations, methods of management in different age groups.

2. Dr. A.MOHAN KRISHNA
M.S.ORTHO, MCh ORTH(U.K)
Consultant Orthopaedic surgeon ,
Trauma, Arthroscopy,
Arthroplasty Surgeon
Apollo hospitals, Hyderabad
Consultant Orthopedic Surgeon at
www.drmohankrishna.com
www.healthyjointclub.com
www.bonesandjointsclinic.com

3. This presentation is solely for educational purpose.
The material included in the presentation
represents educational material for the patients
and not intended for any treatment purpose
DISCLAIMER

4. HIP FRACTURES
BALL-AND-SOCKET JOINT: Ball
shaped femoral head and cup shaped
acetabulum
The upper end of thigh bone is made up
of femoral head, neck and trochanter
Hip fractures can occur at
-Femoral head,
-neck
-trochanter

5. HIP FRACTURES: FEMORAL
NECK FRACTURES
Fracture adjacent to the femoral head in the
neck between the head and the greater
trochanter

6. FEMORAL NECK FRACTURES:
CAUSES
Elderly : Common / weak
osteoporotic bone
Common cause in elderly :
- Due to slip and fall on the hip
- Direct blow on the hip
- Trivial twisting injury to the leg

7. FEMORAL NECK FRACTURES: CAUSES
Young :
-High velocity road traffic accidents
-Fall from heights

8. FEMORAL NECK FRACTURES:
COMPLAINTS
-Pain in the injured hip
-Inability to bear weight
- Inability to move the hip
-Bruising over hip and groin

9. FEMORAL NECK FRACTURES:
MANAGEMENT
Fall/injury to
hip
Emergency/Clinic
X –rays & Necessary tests

10. FEMORAL NECK FRACTURES:
INVESTIGATIONS

11. FEMORAL NECK FRACTURES:
MANAGEMENT
Diabetes/Hypertension
Cardiac /Neurological
conditions
Kidney / liver
problems
Physician /
Diabetologist opinion
Cardiologist /
neurologist opinion
Specialist opinion

12. FEMORAL NECK FRACTURES:
MANAGEMENT
2D Echo
Blood tests
Chest X ray/
ECG

13. FEMORAL NECK FRACTURES:
MANAGEMENT
Head of Femur :
Precarious blood supply
– Injury or fracture
damages blood supply
Avascular necrosis
subsequent arthritis
Young individuals
Up to age of 50 years
Preserve Head by
fixing the fracture
Elderly : above 50
years / weak
osteoporotic bone
Replace Head of femur
Hemiarthroplasty/
Total Hip replacement.

14. FEMORAL NECK FRACTURES: FIXING
FRACTURE NECK OF FEMUR
SCREW
FIXATION:
- Under Spinal anaesthesia
- Fracture is reduced
- Fixed with 2 or 3 screws
- Special X ray machine – C-Arm is used
- Done through small incision on upper
part of thigh

15. FIXING FRACTURE NECK OF FEMUR
DYNAMIC HIP
SCREW
FIXATION (DHS)
- Under Spinal anaesthesia
- Fracture is reduced
- Fixed with large screw and side plate
assembly
- Special X ray machine – C-Arm is used
- Done through small incision on upper part of
thigh

16. FIXING FRACTURE NECK OF FEMUR
DAY 1 in the hospital
• Moving in and out of bed
• Walking with the help of walker without weight
on operated leg
Day 2
• Plan for discharge
• Basic exercises in bed
Discharge advice
• Revisit after 2 weeks for stitch removal
• Not to sit on the ground or cross legged

17. POST OPERATIVE FOLLOW UPAFTER
FIXING HIP FRACTURES
6 weeks follow up
• X-ray to see progress of healing
• Partial weight bearing with walker
3 months after surgery
• X ray to see the progress of healing
• Full weight bearing on the operated leg
3 months to 6 months after surgery
• Fracture healing takes 3 to 6months
• Follow up every 6 weeks till fracture heals

18. FIXING FRACTURE NECK OF FEMUR
Implant failure Nonunion
Avascular necrosis of head
of femur
Infection
Complications

19. FEMORAL NECK FRACTURES:
HEMIARTHROPLASTY
Elderly : above 50
years / weak
osteoporotic bone
Replace Head of femur
- Hemiarthroplasty
- Total Hip replacement.
HEMIARTHROPLASTY:
Surgery in which ball of the
hip joint replaced by metallic
ball

20. HEMIARTHROPLASTY: Surgery
HEMIARTHROPLASTY:
-Spinal anaesthesia.
- Hip joint is opened and ball is removed.
- Thigh bone is prepared to hold the prosthesis with or without the
help of cement.
- Artificial ball is relocated into the acetabulum of hip joint.

21. Day 1
Exercises for ankles and toes to prevent blood clots.
Full weight bearing walking with walker.
You can sit on a chair or take a few steps with a frame
Day 2
Removal of bandage and drain from the Hip joint
Knee exercises – straightening / bending.
Allowed to go to bathroom.
Day 3
Walking up and down the stairs
Continue the exercises
You may be able to go home
within 3 to 4 days after the
operation
HEMIARTHROPLASTY: Postoperative advice

22. Stitches / clips removed
at 12 - 14 days
You can shower/ bathe after
removal of stitches / clips
Return to household work & other
day to day activities in 6-8 weeks
HEMIARTHROPLASTY: Postoperative
advice

23. Frequent deep
breathing1
Pull your toes towards
you and point away.
2
Circle your feet in
both directions
3
Push knee down
Tighten thigh muscles
Count to 10 and relax
Do it 10 times / hour
4
Place a rolled towel
under your knee. Lift
your heel to straighten
knee. Count to 10 and
do 10 times / hour
5
Place a rolled towel
under your knee.
Push your knee and
heel down. Count to
10 and do 10 times /
hour
6
HEMIARTHROPLASTY: Exercises

24. Sit at the edge of bed / chair. Bend
the operated leg and straighten
slowly. Repeat 10 times/hour.
7
Note: it is important to do frequent repetitions of all exercises for a short
time than spending more time on exercises once or twice a day. Do not
force any movements
HEMIARTHROPLASTY: Exercises

25. Raise and support your
operated leg on a stool
Do walk short distances initially
As you get stronger increase
the distance of walking
HEMIARTHROPLASTY

26. HEMIARTHROPLASTY: COMPLICATIONS
Infection Deep vein thrombosis(DVT)
Neurovascular injuries Dislocation of prosthesis
complications

27. CONTACT
Dr.A.MOHAN KRISHNA
M.S.Ortho., MCh Ortho(U.K).,
Consultant Orthopaedic Surgeon,
Apollo Hospitals,
Hyderabad.
Appointments: Secretary : 09247258989
09441184590
08332936085
www.drmohankrishna.com
www.healthyjointclub.com
www.bonesandjointsclinic.com
Email: bonesandjointsclinic@gmail.com