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femoral neck fractures classifications.ppt

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					Femoral Neck Fractures
    classifications


    Dr Mehdi Ziaei
  orthopedic surgeon
       Hemi



ORIF
              THR
                    Anatomy
• Physeal closure age 16
• Neck-shaft angle
     130° ± 7°
• Anteversion
     10° ± 7°
• Calcar Femorale
      Posteromedial
      dense plate of bone
                 Blood Supply
• Lateral epiphysel artery
   – terminal branch MFC artery
   – predominant blood supply to
     weight bearing dome of head
• Artery of ligamentum teres
   – from obturator artery
   – supplies anteroinferior head
• Lateral femoral circumflex a.
   – less contribution than MFC
               Blood Supply
• fracture displacement=vascular
  disruption
• revascularization of the head
  – intact vessels
  – vascular ingrowth across fracture site
     • importance of quality of reduction
  – metaphyseal vessels
                Epidemiology
• 250,000 Hip fractures annually
  – Expected to double by 2050
• At risk populations
  – Elderly: poor balance&vision, osteoporosis, inactivity,
    medications, malnutrition
     • incidence doubles with each decade beyond age 50
  – higher in white population
  – Other factors: smokers, small body size, excessive
    caffeine & ETOH
  – Young: high energy trauma
                   Classification
• Pauwels [1935]
   – Angle describes vertical shear vector
                     Classification
• Garden [1961]
I    Valgus impacted or
     incomplete
II Complete                    I      II
    Non-displaced
III Complete
    Partial displacement
IV Complete
    Full displacement
** Portends risk of AVN
    and Nonunion               III    IV
               Classification
• Functional Classification
  – Stable
     • Impacted        (Garden I)
     • Non-displaced   (Garden II)
  – Unstable
     • Displaced       (Garden III and IV)
•.   The AO classification of
 intracapsular proximal femoral
            fractures
              Stress Fractures
• Patient population:
  – Females 4–10 times more common
     • Amenorrhea / eating disorders common
     • Femoral BMD average 10% less than control
       subjects
  – Hormone deficiency
  – Recent increase in athletic activity
     • Frequency, intensity, or duration
     • Distance runners most common
              Stress Fractures
• Clinical Presentation
  –   Activity / weight bearing related
  –   Anterior groin pain
  –   Limited ROM at extremes
  –   ± Antalgic gait
  –   Must evaluate back, knee, contralateral hip
                   Stress Fractures
• Imaging
   – Plain Radiographs
       • Negative in up to 66%
   – Bone Scan
       • Sensitivity 93-100%
       • Specificity 76-95%
   – MRI
       • 100% sensitivity / specificity
       • Also Differentiates: synovitis, tendon/
         muscle injuries, neoplasm, AVN,
         transient osteoporosis of hip
              Stress Fractures
• Classification
  – Compression sided
     • Callus / fracture at inferior aspect femoral neck
  – Tension sided
     • Callus / fracture at superior aspect femoral neck
  – Displaced
The End

				
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posted:3/13/2013
language:Latin
pages:19