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Hip fracture
(proximal femur fracture)
Risk factors
 Increases
with increasing age
 > 50y/o, 2 times for each decade
 Women: male 2.5: 1
 Urban dwelling,smoking,alcohol,
caffeine,physical inactivity,psychotropic
medication,senile dementia
 Weight loss >10% (>50 y/o)
 osteoporosis
Mechanism
A simple fall ( 90 %)
Mortality
 1-year
mortality: 12%-36%
 High mortality within first 4-6 months after
fracture
 Higher mortality: advanced age,systemic
dusease,male,institutionalized living,psychiatric
illness
 Delayed surgery: (> 2days) : doubled the mortality
within first year
Treatment principles
 Early
mobilization, prevent decubiti,
atalectasis,UTI.thrombophlebitis
 Surgery within 24 hours
 To walk within 2 weeks after surgery
Classification
Femeral neck fracture
 Intertrochanteric fracture
 Subtrochanteric fracture

Anatomy
 Blood
supply: Ascending cervical branches of
lateral and medial femoral circumflex artery ,
Arteries of ligamentum teres
 Capsule: attached anteriorly at the intertrochanteric
line; Posteriorly the lateral half of neck
Femeral neck fracture
General considerations
 Intracapsular
fracture
 Not covered by periosteum;
no callus formation
 Endosteal healing
Classification(Garden)


Non-displaced fractures
Garden I: incomplete or impacted fracture
Garden II: complete fracture without displacement
Displaced fractures
Garden III: complete fracture with partial displacement
Garden IV: complete fracture with total displacement
Diagnosis
Non-displaced and impacted fractures
a. Pain with range of motion or percussion
over the trochanter
b. X-ray is often negative initially:tomograms
or bone scan may be needed
Diagnosis
Displaced fractures
a. Shortened or externally rotated extremity
b. AP and lateral x-ray reveal changed
neck-shaft angle
Treatment
Non-displaced fractures


Knowles pins or Cannulated screws
nonweight-bearing for 3 months
Treatment
Displaced fractures
<60 years: Knowles pins or cannulated screws with
or without vascular bone graft
60~80 years:Hemiarthroplasty with Bipolar
prosthesis
>80 years: Hemiarthroplasty with Austin-Moore
prosthesis
Complications
non-union and avascular necrosis
Intertrochanteric
fractures
General considerations
 Exuracapsular
fracture with better healing potential
 Age:10 years older than femoral neck fracture
Classification(Boyd & Griffin)
Stable fractures
 Type I: Nondisplaced fracture
 Type II: Displaced fracture
Unstable fractures
 Type III: Reverse,subtrochanteric,or
posteromedial comminution fracture
 Type IV: Intertrochanteric fracture with
subtrochanteric fracture
Stability of fracture



Integrity of the posteromedial cortex is
the most important factor
Reverse fracture is more unstable
Subtrochanter fracture is more unstable
Treament

Stable fractures:
Close reduction with DHS(Dynamic hip
screw)
 Unstable fractures:
Close reduction Gamma-nail(Small lever
arm)
Complications
Less non-union or avascular necrosis
 Malunion happened in unstable
fractures

Thank you ( 3q )
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