Femoral Neck Fractures
Femoral Neck Fractures
Femoral Neck Fractures
the birth: Blood supply of the head is derived from three sources.
Medial ascending cervical (inferior metaphyseal of Tracta) arteries.
Lateral ascending cervical (lateral epiphyseal of Tracta) arteries.
Vessels of the ligamentum teres only a limited area near the fovea.
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seen:
Extracapsular fracture
Through the intertrochanteric line or
lateral to it.
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poor purchase for internal fixation devises. So, the tip of the fixation
devise should not lie in this area and must cross this triangle.
Q: What is the significance of fracture neck of femur in young
people?
Femoral neck fracture in young people is either (a) Result of high energy
trauma or, (b) Pathological fractures e.g. fibrous dysplasia or tumours.
Q: Give classification of fracture neck of femur in children.
Delberts classification of femoral neck fracture in children:
Type I Transepiphyseal separations, with or without dislocation of
femoral head from the acetabulum.
Type II Transcervical fractures, displaced or nondisplaced.
Type III - Cervicotrochanteric fractures, displaced or nondisplaced.
Type IV - Intertrochanteric fractures.
Q: What is Pauwels angle and Parlingtons angle?
The angle of the fracture line of the neck of the femur that forms with
respect to horizontal line is known as Pauwels angle and the angle formed
with respect to vertical line is Parlingtons angle. Various degrees of these
angles indicate the amount of displacement of fracture fragments and
thus the progress.
Q: What are the differences between transcervical and basal neck
fractures?
1.
2.
3.
4.
5.
Transcervical fractures
Fracture line passes through the
middle of the neck.
Intracapsular.
Reduction
and
fixation
comparatively difficult.
Fixation
device
used
cancellous screws.
Prognosis usually poor as it is
intracapsular.
5. Bone quality
6. Socioeconomic condition of the patient
7. General physical condition of the patient
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Traction in leg with hip flexed at 90o and femoral shaft in slight
abduction in the long axis of femur to cause disimpaction.
The leg is then brought into abduction, internal rotation and extension.
Q: When full weight bearing is allowed after internal fixation of
femoral neck fracture?
Full weight bearing is allowed after radiological evidence of union.
Q: What are the advantages of cannulated hip screws?
1. Screws can be inserted over a guide pin which is introduced previously
in correct position, checked by radiography.
2. Decompression of the intracapsular tamponade can occur through the
cannulated screws, thus helps in healing by improving circulation.
Q: What are the complications of femoral neck fracture?
Complications are
1. Nonunion
2. Malunion e.g. varus or valgus
3. Avascular necrosis of femoral head
4. Infection
5. Thromboembolism
Q: Why AVN is so high in type-III and IV femoral neck fractures?
Due to displacement of fracture fragments there is more damage to
retinacular vessels and second trauma also during reduction and
internal fixation.
Anatomical reduction is not possible most of the times in these types of
fractures.
Q: How many times close reduction can be tried in femoral neck
fracture?
Attempts of close reduction should not be tried more than twice. If such
attempts are tried more than twice, there will be more damage to
vascularity and AVN or nonunion will develop later on.
Q: What is Girdle-Stone operation? What is its another name?
Excision of the femoral head is known as Girdle-Stone operation. It is also
known as excision hemiarthroplasty.
Q: Why pain is relieved following Girdle-Stone operation?
Pain producing nerve endings are destroyed by cutting the capsule.
No friction between the fracture fragments.
Q: What are the disadvantages of Girdle-Stone operation?
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2. Gluteus minimus
4. Quadratus femoris
6. Sartorius
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