![]() While prosthetic replacement is reserved for fractures with high risk of AVN and the elderly. ![]() Īs a general rule, internal fixation is recommended for young, otherwise fit patient with small risk for AVN. Table 14.3 Delbet Classification for risk of AVN with femoral neck fracture. The Delbet classification correlates with the risk of AVN: Type High morbidity and mortality associated with hip and pelvic fractures after trauma has been well documented. Prognosis is varied, but is complicated by advanced age, as hip fractures increase the risk of death and major morbidity in the elderly. Replacing the femoral head is achieved with either hemiarthroplasty or total hip arthroplasty. Internal fixation can be performed with multiple pins, intramedullary hip screw (IMHS), crossed screw-nails or compression with a dynamic screw and plate. The treatment options include non-operative management, internal fixation or prosthetic replacement. Summary: The purpose of this presentation is to describe the Gotfried (nonanatomical) reduction. A valid radiographic classification system is mandatory to perform the correct treatment and to allow surgeons to facilitate communication. Significant complications such as avascular necrosis (AVN) and non-union are very common without surgical intervention. The Gotfried (nonanatomical) reduction technique of unstable subcapital femoral fractures involves creation of a positive buttress between the proximal and distal fracture parts to prevent future reduction deterioration once fracture line bone resorption takes place as well as reduction in valgus. Background Femoral neck fractures (FNF) are one of the most common injury in the elderly. Primary total hip replacement for displaced subcapital fracture of the femur. Non-displaced fractures may be subtle on x-ray Displaced subcapital and intracapsular femoral neck fractures unsuitable for.Femur often positioned in flexion and external rotation (due to unopposed iliopsoas).Lesser trochanter is more prominent due to external rotation of femur.Shenton’s line disruption: loss of contour between normally continuous line from medial edge of femoral neck and inferior edge of the superior pubic ramus.The mechanism in young patients is predominantly axial loading during high energy trauma, with an abducted femur position resulting in a femoral neck fracture while an adducted femur position often results in a fracture-dislocation of the hip with secondary acetabular injury. In elderly patients, the mechanism of injury varies from falls directly onto the hip to a twisting mechanism in which the patient’s foot is planted and the body rotates. motor vehicle collisions) in younger patients. Transcervical: mid-portion of femoral neck.Neck of femur fractures are considered intracapsular fractures. Avascularity of the femoral head is more common with fractures that are cranially situated in the femoral neck. We help you select the appropriate treatment of Impacted or nondisplaced subcapital femoral neck fractures located in our module on Proximal femur. Since disruption of blood supply to the femoral head causes significant morbidity, diagnosis and classification of these fractures is important. Hand Distal phalanges revision published. The femoral neck is the weakest part of the femur. Lesser the angulation more stable the fracture with a better a prognosis.\)įemoral neck fractures are a subset of proximal femoral fractures. Pauwel classification is based on post-reduction angulation of fracture line to the horizontal evaluated on a AP radiograph. Type IV: complete, unstable and fully displaced Type III: complete, unstable and partially displaced Type II: complete, stable and undisplaced ![]() Prospective randomized controlled trial comparing dynamic hip screw and screw fixation for undisplaced subcapital hip fractures. Type I: is incomplete, stable and impacted The DHS has slight advantages for the management for displaced femoral neck fractures. Further, the displacement is graded as per the position of the principal (medial) compressive trabeculae. Anteroposterior radiograph of the left hip (A) demonstrates a subcapital femoral neck fracture. The femoral neck is the weakest part of the femur. A and B, Subcapital femoral neck fracture. In this procedure, surgical pins or screws are passed across the fracture site to hold the ball of the femur in place while the fracture heals. If a femoral neck fracture is not displaced, the most common treatment is in-situ pinning. Garden classification is based on the pre-reduction displacement of the femoral head. Femoral neck fractures are a subset of proximal femoral fractures. This type of fracture is also sometimes called a subcapital or intracapsular fracture. ClassificationĪlthough many classifications are proposed Garden classification and Pauwel classification are generally followed from a practical point of view as these two systems take into consideration the stability of the fractures. ![]() The fracture line extends through the junction of the head and neck of femur. Subcapital fracture is the most common type of intracapsular neck of femur fracture.
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