Hip Fractures types ,classification and treatment

Описание: Hip Fractures types ,classification and treatment . check my book on Amazon https://www.amazon.com/dp/B0C51X2CWB?...
Femoral neck fractures can occur as a result of low energy trauma as in the elderly. Femoral neck fractures can also occur due to high energy trauma, such as with falls or motor vehicle accidents. Anatomic classification of femoral neck fractures includes subcapital, transcervical, basicervical. Subcapital is common. There are two famous classifications of subcapital fractures: Garden classification and Pauwel’s classification. Garden classification classifies the fractures according to the amount or degree of displacement. There are four types. It relates the amount of displacement to the risk of vascular disruption. This classification applies to the geriatric and insufficiency fractures.it is classified into two groups: nondisplaced are type I and type II, and displaced are type III and type IV. Garden classification type I is incomplete and impacted in valgus. Type II fracture is complete and nondisplaced on at least two planes (anteroposterior & lateral). Type III is a complete fracture and partially displaced. The trabecular pattern of the femoral head does not line up with the acetabular trabecular pattern. Type IV is a completely displaced fracture with no continuity between the proximal and distal fragments. The trabecular pattern of femoral head remains parallel with the acetabulum trabecular pattern. There are three types within the Pauwel’s classification. Pauwel’s classification classifies the fracture according to the orientation and direction of the fracture line across the femoral neck. It relates to the biomechanical stability. The more vertical the fracture, the more shear forces, and the more complication rate. Type I has an obliquity ranging from 0-30 degrees. Type II has an obliquity ranging from 30-50 degrees. Type III has an obliquity between 50-70 degrees or more. As the fracture progresses from Type I- Type III, the obliquity of the fracture line increases. As the fracture line becomes more vertical, the shear forces increase and the instability increases. A horizontal fracture is good and stable. A vertical fracture is bad and unstable. The more displaced the fracture, the more disruption of the blood supply and the chance of avascular necrosis and nonunion (can occur in about 25% of displaced fractures). If nonunion occurs in a younger patient, you may help the patient by doing subtrochanteric osteotomy to reorient the fracture line from vertical to horizontal (will help the fracture healing). In femoral neck fractures associated with femoral shaft fractures, the typical neck fracture is vertical and nondisplaced. It may require internal rotation view x-rays to see this hip fracture (fracture could be missed). Fix the femoral neck fracture first, followed by the femoral shaft fracture. The usual combination is parallel screws in the femoral neck and a retrograde femoral rod for the fractured femur. Pipkin type II fracture is fracture of the femoral head, dislocation of the hip, and fracture of the femoral neck. Try to avoid reduction of the hip dislocation by closed means (especially in the young patients). You may want to do open reduction of the hip dislocation especially if the femoral neck fracture is not displaced. Stress fracture is more common in female athletes. It can be tension fractures. Fracture or callus is present on the superior aspect of the femoral neck. Adult bone is weak in tension, so stress fracture of the femoral neck needs to be fixed. This should be an emergency operation before the fracture displaces. With compression fractures, the compression or callus is present on the inferior aspect of the femoral neck. Some people believe that if the compression fracture is less than 50% across the neck, then the fracture could be stable and you can do protected crutch ambulation. If the compression fracture is more than 50% across the neck, then the fracture is unstable and you will do ORIF. Some surgeons fix all stress fracture of the femoral neck. A female runner with groin pain will rule out stress fracture. Get an MRI, and you will probably have to fix the fracture. Femoral neck fractures can also occur due to insufficiency fracture. This occurs due to weak bone because of osteoporosis or osteopenia. The patient will have groin pain, pain with axial compression, and the x-ray may be normal (MRI is helpful in diagnosing insufficiency fracture).
special thanks for NATHAN ELKINS FOR HIS CONTRIBUTION TO THIS VIDEO