Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.įigure 14.12B X-ray of the femur, post-operative arthroplasty by Dr. While prosthetic replacement is reserved for fractures with high risk of AVN and the elderly.įigure 14.12A X-ray of the femur, pre-operative femoral neck fracture by Dr. 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. Significant complications such as avascular necrosis (AVN) and non-union are very common without surgical intervention. Non-displaced fractures may be subtle on x-ray.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. BACKGROUND: Traction bed C-arm X-ray machine is used for closed reduction and internal fixation to treat femoral neck fracture has some errors. 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. Since disruption of blood supply to the femoral head causes significant morbidity, diagnosis and classification of these fractures is important. Subsequent images revealed that the patient had surgical management of this fracture resulting in the placement of an Austin-Moore prosthesis.įemoral neck fractures are a subset of proximal femoral fractures. The femoral neck is the weakest part of the femur. The distal femur was displaced cranially and laterally. There was a fracture of the high femoral neck on the right. Lesser the angulation more stable the fracture with a better a prognosis.ODIN Link for Femoral Fracture images (Pre and Post-Op), Figure 14.12A and B: Figure 14.12A X-ray of the femur, pre-operative femoral neck fractureįigure 14.12B X-ray of the femur, post-operative arthroplasty Imaging Assessment 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 ![]() Four major medical databases and a combination of the search terms of femoral neck fractures. Methods Reviewed was the literature on non-displaced femoral neck fractures in elderly patients. We also discussed the surgical and non-surgical treatments and selection of implants. Type III: complete, unstable and partially displaced Background This paper aimed to review the databases on non-displaced femoral neck fractures in elderly patients. ![]() Type II: complete, stable and undisplaced Type I: is incomplete, stable and impacted Further, the displacement is graded as per the position of the principal (medial) compressive trabeculae. Garden classification is based on the pre-reduction displacement of the femoral head. 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. displaced subcapital fractures of the femur. Subcapital fracture is the most common type of intracapsular neck of femur fracture. A new method for prognostication of non-union in subcapital femoral neck fractures is presented.
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