FRACTURE OF THE FEMORAL

NECK

SITI NUR BAITI BINTI SHAIK

KHAMARUDIN
012013100196
 Fracture usually results
from direct fall onto
greater trochanter.
Common in elderly
osteoporotic people.
less force required
Young fall from
height or blow
sustained in road
accident.
Can be displaced
Increased risk of
avascular necrosis
GREATER
(AVN). TROCHAN
TER
 COMPLETE
COMPLETE COMPLETE
INCOMPLET FRACTURE
FRACTURE FRACTURE
E PARTIAL
NO FULL
FRACTURE DISPLACEM
DISPLACEM DISPLACEM
ENT
ENT ENT
 SPECIAL FEATURES

History of fall.
Followed by pain
in hip.
If displaced,
patient will lie in
lateral rotation &
leg will look
short.
 X-RAYS FINDINGS
Is there a
Is it displaced?
fracture?

Displacement:
Abnormal shape of
bone images
Degree of mismatch
of trabecular lines in
femoral head &
neck and the
supraacetabular
bone.
Assessment from X-rays:
Impacted or undisplaced fractures do
well after internal fixation.
Displaced fractures Non-union

Avascular
necrosis
 TREATMENT
Operative treatment.
o Impacted fractures can be left
risk become displaced fixation is
Principles: safer
a) accurate reduction
Manipulation under anaesthesia
Reduction checked by x-ray.
b) secure fixation
Securely fixed with cannulated
screw or a sliding (dynamic)
compression screw attached to
shaft.
c) early activity
Sit up in bed or in a chair.
Walking with crutches.
 WHAT IF FRACTURE
CANNOT BE ACCURATELY
REDUCED?
Patients > 60 years old

Partial or total hip replacement

Patients < 60 years old

Trying open reduction rather

than joint fixing
FRACTURES IN CHILDREN

Undisplaced

Plaster cast (a hip spica)

until unites
Displaced

Reduced and fixed with

screws
 COMPLICATIONS
General
complicatio
ns

Osteoarthri Avascular
tis necrosis

Non-union
(A) General complications
Thromboembolism, pneumonia,
bed sores.
(B) Avascular necrosis
30% - displaced fracture
10% - undisplaced fracture
Branches of blood supply are torn
causing ischemia of femoral head.
Bone dies, eventually collapsed.
 AVASCULAR
NECROSIS
Blood supply is
compromised.
6 months later
obvious femoral
head necrosis.
Section across
the excised
femoral:
necrotic
segment
splitting of
(C) Non-union
High risk if severely displaced.
Patients complain of pain, shortening of limb
& difficulty with walking.
Treatment:
< 50 y/o: secure union by placing bone
graft across fracture & reinserting fixation
device.
> 50 y/o: prosthetic femoral head or total
replacement of joint.
(D) Secondary osteoarthritis
Due to subarticular bone necrosis or femoral
head collapse.
Joint replacement if symptoms warrant.
INTERTROCHANTERIC
FRACTURES
 Fractures between greater and lesser trochanter.
Common in elderly osteoporotic women.
Fractures usually unite easily, seldom cause AVN.
Classification:
degree of comminution = instability = complexity.
 CLINICAL FEATURES

History of fall
Pain
Unable to stand
Limb is
shortened
Lies in external
rotation
X-RAYS

Fracture usually
runs diagonally
from greater to
lesser trochanter.
 TREATMENT
Operative early internal fixation.
To obtain best possible position
To get patients up and walking as soon as
possible.
Commonly reduction done under x-ray
control

Fixed with a compression screw & plate

Allowed to weightbear using crutches
for 8-12 weeks.
 Severely comminuted and reverse
similar device used for
subtrochanteric fractures

Intramedull
95 ary nail
degree with
screw proximal
and interlocking
plate screw into
femoral
device head
 COMPLICATIONS
General

Thromboembolism, pneumonia, bed sores

Failure of fixation

Screws may cut out of the osteoporotic bone if

poor reduction.
Reduction & fixation need to be re-done.

Malunion

Varus and external rotation deformities.

Seldom severe.
 REFERENCE
Louis Solomon, et al. Injuries of the
Hip and Femur. Apley and Solomons
Concise System of Orthopaedics and
Trauma. 2014; Fracture of the
femoral neck: 432-435,
Intertrochanteric fractures: 435-436.