Intracapsular femoral neck fractures

Intracapsular femoral neck fractures

Intracapsular fractures are further broken down into whether they are displaced or undisplaced. Undisplaced intracapsular fractures are generally stable and interruption of the blood supply to the femoral head is rare. Therefore, treatment is aimed at ensuring that the head fragment does not displace during rehabilitation. This can be achieved with cannulated screws inserted along the femoral neck into the head. - A displaced intracapsular fracture may cause disruption of the blood supply either through direct injury to the arteries (a) (b) or joint capsule intra-articular haematoma can a ff ect the sur vival of the femoral head, leading to avascular necrosis. If the patient is physiologically young, reduction and internal fixa tion with cannulated screws or a dynamic hip screw might be attempted to preserve the native head. If the pa tient is older and would benefit from a single oper ation, the head may be sacrificed and replaced with a pros thetic head. Arthroplasty of the pr oximal femur may take the form of hemiarthroplasty or total hip replacement, depending on the patient’s functional demands. Extracapsular femoral neck fractures If the fracture is extracapsular, vascularity of the head is not an issue. Extracapsular femoral neck fractures are subdivided into stable or unstable. Unstable fractures include a reverse oblique pattern or where the medial calcar is a comminuted (lesser trochanter) fracture. Stable extracapsular fractures simply require connection of the head to the shaft, often using a dynamic hip screw ( Figure 32.26 ). In unstable fractures a dynamic hip screw can also be used, but, owing to the unfavourable mechanical environment relat ing to the loss of the medial calcar or a reverse oblique patter an intramedullary device might be considered.

Dynamic hip screw Smooth bar re l in which screw can slide Figure 32.26 (a) A dynamic hip screw for /f_i xing a trochanteric proxi mal femoral fracture. This allows for compression at the fracture site on load-bearing and protects the femoral head from penetration by the screw when the osteoporotic bone settles; (b) insert to show the sliding screw in the barrel.

Intracapsular femoral neck fractures

Intracapsular fractures are further broken down into whether they are displaced or undisplaced. Undisplaced intracapsular fractures are generally stable and interruption of the blood supply to the femoral head is rare. Therefore, treatment is aimed at ensuring that the head fragment does not displace during rehabilitation. This can be achieved with cannulated screws inserted along the femoral neck into the head. - A displaced intracapsular fracture may cause disruption of the blood supply either through direct injury to the arteries (a) (b) or joint capsule intra-articular haematoma can a ff ect the sur vival of the femoral head, leading to avascular necrosis. If the patient is physiologically young, reduction and internal fixa tion with cannulated screws or a dynamic hip screw might be attempted to preserve the native head. If the pa tient is older and would benefit from a single oper ation, the head may be sacrificed and replaced with a pros thetic head. Arthroplasty of the pr oximal femur may take the form of hemiarthroplasty or total hip replacement, depending on the patient’s functional demands. Extracapsular femoral neck fractures If the fracture is extracapsular, vascularity of the head is not an issue. Extracapsular femoral neck fractures are subdivided into stable or unstable. Unstable fractures include a reverse oblique pattern or where the medial calcar is a comminuted (lesser trochanter) fracture. Stable extracapsular fractures simply require connection of the head to the shaft, often using a dynamic hip screw ( Figure 32.26 ). In unstable fractures a dynamic hip screw can also be used, but, owing to the unfavourable mechanical environment relat ing to the loss of the medial calcar or a reverse oblique patter an intramedullary device might be considered.

Dynamic hip screw Smooth bar re l in which screw can slide Figure 32.26 (a) A dynamic hip screw for /f_i xing a trochanteric proxi mal femoral fracture. This allows for compression at the fracture site on load-bearing and protects the femoral head from penetration by the screw when the osteoporotic bone settles; (b) insert to show the sliding screw in the barrel.

Intracapsular femoral neck fractures

Intracapsular fractures are further broken down into whether they are displaced or undisplaced. Undisplaced intracapsular fractures are generally stable and interruption of the blood supply to the femoral head is rare. Therefore, treatment is aimed at ensuring that the head fragment does not displace during rehabilitation. This can be achieved with cannulated screws inserted along the femoral neck into the head. - A displaced intracapsular fracture may cause disruption of the blood supply either through direct injury to the arteries (a) (b) or joint capsule intra-articular haematoma can a ff ect the sur vival of the femoral head, leading to avascular necrosis. If the patient is physiologically young, reduction and internal fixa tion with cannulated screws or a dynamic hip screw might be attempted to preserve the native head. If the pa tient is older and would benefit from a single oper ation, the head may be sacrificed and replaced with a pros thetic head. Arthroplasty of the pr oximal femur may take the form of hemiarthroplasty or total hip replacement, depending on the patient’s functional demands. Extracapsular femoral neck fractures If the fracture is extracapsular, vascularity of the head is not an issue. Extracapsular femoral neck fractures are subdivided into stable or unstable. Unstable fractures include a reverse oblique pattern or where the medial calcar is a comminuted (lesser trochanter) fracture. Stable extracapsular fractures simply require connection of the head to the shaft, often using a dynamic hip screw ( Figure 32.26 ). In unstable fractures a dynamic hip screw can also be used, but, owing to the unfavourable mechanical environment relat ing to the loss of the medial calcar or a reverse oblique patter an intramedullary device might be considered.

Dynamic hip screw Smooth bar re l in which screw can slide Figure 32.26 (a) A dynamic hip screw for /f_i xing a trochanteric proxi mal femoral fracture. This allows for compression at the fracture site on load-bearing and protects the femoral head from penetration by the screw when the osteoporotic bone settles; (b) insert to show the sliding screw in the barrel.