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Clinical Anatomy of Proximal Femur
Dr. Khushwant Singh Rathore
Department Of Orthopedics
All India Institute Of Medical
Sciences, Jodhpur
What is intra-capsular neck femur
fracture?
What is extra-capsular
intertrochanteric femur fracture?
What is sub-trochanteric fracture?
Why they behave differently?
Intra-capsular
Fracture
Non-union
Osteonecrosis
Extra-capsular
fracture
Mal-union
shortening
Sub-trochanteric
fracture
Nonunion
Varus deformity
Lessons from Anatomy
Why neck femur fracture goes into
osteonecrosis?
Direct disruption
of the intra-
capsular arteries
End arterial
blood supply
Intra-capsular
Tamponade Ischemia &
Nonunion
Synovial
Fluid
Dilution of fracture
hematoma
Collagenases
Angiogenesis
inhibitors
Problems with intertrochanteric
fractures(Extra-capsular#)
 Vascularity is not an issue – problem of plenty
 Cancellous bone – Union is not an issue
 Issue is Mal-union & Coxa vara
Displacing forces in intertrochanteric
fractures
Problems with sub-trochanteric
fracture?
Deforming muscle forces (arrows) acting on
a subtrochanteric femur fracture. Antero-
posterior view showing varus deformity
caused by strong abductors acting on the
proximal segment (A). Lateral view showing
flexion caused by iliopsoas (B).
Clinical application of relevant
anatomy

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