Classification according to Pauwells’ angle
• Pauwells’ angle >50º is adduction fracture, which is a more vertical and unstable fracture that produces a high risk of union
coxa vara.
The femoral anterersion angle
Epidemiology
1. increased freq with
age dementia malignancy chronic illness, osteoporosis
2. decreased freq with
• Femoral neck factures in young adults are generally associated with highenergy trauma such as motor vehicle accidents
Mechanism of injury
• In general , mechanism of injury is described as a indirect blow, often associated with forced external rotation of the extremity
Methods of treatment
• Internal fixation 1, multiple pins 2, crossed screw-nails 3, compression with dynamic screw and plate • Arthroplasty AMP for pts more than 70 THR for pts less than 70
• Varus displacement of the femoral head
The Garden classification (GradeⅣ)
• Complete loss of continuity between both fragments
Other classification schemes
Shortening Angulation
Rotation
Descriptive animation
Typical displacement realitive to the different location of the fracture
1.proximal 1/3rd fracture 2. Middle 1/3 rd fracture
• Classification according to fracture intra-or extra-capcular
• Classification according to Pauwell’s angle
Neck of Femur fractures
Intracapsular
Extracapsular
Classification
• There are several classification schemes for femoral neck fractures
• The most commonly used classification is that proposed by Garden
The Garden classification (GradeⅠ)
• Valgus impaction of the femoral head
The Garden classification (GradeⅡ)
• Complete but nondisplaced
The Garden classification (GradeⅢ)
Posterior View • Popliteal artery and vein • Sciatic Nerve
Causes
• usually high energy trauma
Classification
• by location, fracture pattern, comminution, soft tissue injury, mechanism
Lower Extremity Fracture
1st hospital of Xinjiang Medical University
Fracture of proximal part of femur
Anatomy review
Blood supply
4 groups 1. Extracapsular arterial ring 2. Ascending cervical branches 3. Subsynovial intracapsular ring ( Chung) 4. Artery of the lig teres
The principles of therapy
• based on pt age and grade of fracture
1. Pt less than 65 and do not have a chronic illness, poor life expectancy ORIF 2. Pt between 65 and 75 those with high functional demand those with low demand , chronic illness arthroplasty 3. Pt more than 75 arthroplasty ORIF
3. Distal 1/3 rd fracture
proximal 1/3rd fracture
M.gluteus medius M.iliopsoas
M. adductor
Middle 1/3 rd fracture
M.iliopsoas M.gluteus medius
M. adductor
multiple pins
Dynamic screw and plate
Complications
1. AVN(avascular necrosis) • undisplaced fracture ~ 10%
displaced fracture up to ~ 80% either partial or complete (variable reporting)
• late segmental collapse occurs in
~ 10% undisplaced fracture ~ 30% displaced fracture
2. Failure of fixation • Nonunion
rare in undisplaced fracture ~ 30% in displaced fracture treat with either a valgus osteotomy or an arthroplasty
Coronal Section
Bony structure
AP Hip Lateral Hip
The neck shaft angle
When it is >127º ,
collum valgum .
The normal neck shaft angle is 127º .
When it is <127º ,
The Garden classification
• This classification is based on the degree of displacement shown on the anteroposterior (AP)radiograph • The Garden classification is of prognostic value for the incidence of avascular necrosis, the higher the Garden number, the higher the incidence
• DVT/PE (deep vein thrombosis)
DVT ~ 40% low dose warfarin in pts who justify risk of anticoagulation
Nonunion
Fracture of Femoral shaft
Anatomy review
• Shorting and external rotation of the leg, usually external rotation degree 40°~60°
The typical deformity
Diagnosis
• History
• Physical examination • Radiographs
Undisplaced
Displaced
Trochanteric
Subtrochantle
Transtrochanteric
Classification according to fracture line
Intra
Intra-capsular
Extra-capsular
long term physical activity supplemental Vit D3 and Cain elderly women HRT
Causes
• The majority of femoral neck fractures are the result of lowenergy trauma such as a simple fall in the elder population
Distal 1/3 rd fracture