Fracture of Neck of Femur 30

FRACTURE OF
NECK OF FEMUR
FASEEHA FATHIMA
30
CONTENTS
oINTRODUCTION
oMECHANISM O INJURY
oCLASSIFICATION
oCLINICAL FEATURES
oINVESTIGATIONS
oMANAGEMENT
oCOMPLICATIONS
INTRODUCTION
 Commonest site of fractures in elderly
--Older patients with osteoporosis/osteomalacia
 Two types of fractures of neck of femur:
Intracapsular and extracapsular
 Conventionally,
Neck of femur fracture-----intracapsular
Inter-trochanteric fracture---extracapsular
.
BLOOD SUPPLY OF HEAD OF FEMUR
o Femoral head blood supply is from three sources:
Intraosseous cervical vessels
Retinacular vessels
Artery of ligamentum teres
o In fracture of neck of femur,intraosseous cervical

vessels are disrupted.
o Artery of ligamentum teres supplies only a small

portion of head
------if retinacular vessels are damaged in fracture of
neck:
Avascular necrosis of head of femur
MECHANISM OF INJURY
Following a trivial fall----direct
blow over greater trochanter
Major trauma in young adults like
RTA, fall
Uncommon in children
CLASSIFICATION
Anatomical Classification:
Subcapital---beneath the neck
Transcervical---in the middle of neck
Basal---at the base of neck
Pauwel’s Classification
Based on angle of fracture line
forms with respect to horizontal
line:
More angle,more likely to be
unstable
Garden’s Classification
Based on pattern of fracture line and
displacement of fracture
oStage 1: Incomplete
fracture/impacted /abducted fracture
oStage II:Complete but undisplaced
oStage III: Complete fracture with
moderate displacement
oStage IV: Complete fracture with total
displacement
Trabecular between head and neck
Trabecular bending only broken and displaced
Delbet’s Classification in Children
oTransepiphyseal:Junction of the head and
neck
oTranscervical: Through middle of neck
oCervicotrochanteric(basal):junction of
neck and shaft
oIntertrochanteric:In between greater and
lesser trochanter
oPertrochanteric:At the level of trochanter
CLINICAL FEATURES
oPresenting Complaints
Pain
Restriction of movements of affected hip
oSigns
Tenderness over anterior hip line
Minimal shortening
Minimal external rotation
Active leg raising difficult
INVESTIGATIONS
X-ray:Hip joint
Points to be noted:
oFracture
line—complete/incomplete
oFracture Angle
oBreak in Shenton’s line
oDegree of osteoporosis----
Singh’s index
Other investigations
Blood routine
RFT
CT scan
Bone Scan
MANAGEMENT
Impacted Fractures:
Conservative methods for all age groups
Fixed with screws to prevent displacement
Children---hip spica
Adults---immobilisation in a Thomas splint
Displaced fractures
Upto 60 years:Internal Fixation
Multiple cancellous screws
Dynamic Hip Screws
Multiple Knowle’s pins/Moore’s pins----used
in children
Displaced fracture:
More than 60 years
Prosthetic replacement
With otherwise normal Hip. Hip with pre-existing arthritis
Hemiarthroplasty Total Hip replacement

Hemiarthroplasty Severly displaced fracture Total hip replacement
of neck of femur
COMPLICATIONS
Non-union
No evidence of radiological healing
taking place between 6-12 months at
treatment.
McMurray’s displacement osteotomy
Osteotomy made just proximal to lesser trochanter
Distal fragment pushed medially and fixed internally
Role of osteotomy
Helps in converting the shearing force at fracture site
into compression force by changing line of weight-
bearing
Enhances chances of fracture union.
Hemireplacement arthroplasty
Austin Moore’s prosthesis/Thompson’s prosthesis
AVASCULAR NECROSIS
In displaced neck fracture,femoral head
depends on vessels of ligamentum teres for
blood supply
If this becomes insufficient
Avascular Necrosis of a segment/whole head

oInvestigations
X-ray
MRI
Bone scan
oTreatment
Symptomatic treatments like bed rest,NSAIDs
Displacement/angular Osteotomy in early cases
Acetabular cartilage viable--------hemireplacement prosthesis
Acetabular cartilage non-viable----total hip replacement
Other complications
Osteoarthritis
Thromboembolism
REFERENCES
Apley`s System of Orthopaedics and Fractures
John Ebnezar Textbook of Orthopaedics

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FRACTURE OF

o In fracture of neck of femur,intraosseous cervical

o Artery of ligamentum teres supplies only a small

With otherwise normal Hip. Hip with pre-existing arthritis

Hemiarthroplasty Total Hip replacement

If this becomes insufficient

Avascular Necrosis of a segment/whole head

John Ebnezar Textbook of Orthopaedics

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