Proximal femur fractures

Femoral neck fractures

• Increasingly common due to aging population

• Associated with high mortality rate (~25-30% at one year): pre-injury mobility is the most significant determinant for post-operative survival

• Clinical prensetation

  • Pain in the groin or pain referred along the medial side of the thigh and knee

  • Leg in external rotation and abduction, with shortening ( if displaced)

• Classification: Garden (for displacement) and Pauwels (for instbaility)

• Imaging

• Xrays

• Scan / MRI for occulte fracture ( not seen on xrays)

Treatment : Surgery is required ( unless the patient does not ambulate or is at extreme risk for surgical intervention). Many surgical interventions exist according to the type of the fracture

• Osteosynthesis :

  • Cannulated screws

    • Nondisplaced transcervical fx

    • Garden I or II in the physiologically elderly

    • Displaced transcervical fx in young patient (anatomical reduction is urgently needed)

  • Dynamic hip screw

    • Basicervical fracture

    • Vertical fracture pattern in a young patient

• Arthroplasty

  • Total hip replacement vs hemiarthroplasty

Intertrochanteric Fractures

• Extracapsular fractures of the proximal femur between the greater and lesser trochanters

• Nonunion and malunion rates are low

• Classified as stable and unstable

  • Stable: intact posteromedial cortex

  • Unstable:

    • comminution of the posteromedial cortex

    • thinner lateral wall thickness: <20.5 mm suggests risk of postoperative lateral wall fracture

Subtrochanteric fractures

• Subtrochanteric typically defined as area from lesser trochanter to 5cm distal

• Proximal fragment is in abduction, flexion and external rotation

• Distal fragment is in adduction and shortened