OWL: OCOSH Classification/Trauma/Fractures/Femur Fractures/Hip Fractures/Femoral Neck Fractures

Avoiding Missed Femoral Neck Fractures

Tournetta et al — 2005-09-05 23:42:33 GMT

OTA paper 2004: Improvement by Using a Standard Protocol in Cases of Femoral Shaft Fractures:
The purpose of this study was to describe a program of quality improvement and a subsequent protocol that have resulted in a reduction of missed femoral neck fractures in patients with femoral shaft fractures

Comminuted Lower-Extremity Fractures Secondary to Trauma

Not Available — 2005-09-04 23:42:33 GMT

Reports from Medscape Orthopaedics and Sports Medicine 1999
Ipsilateral femoral neck and shaft fractures
Fracture Healing in Tibia Fractures With an Associated Vascular Injury
The Treatment of Lisfranc Injuries
Open Fractures of the Patella: Long-term Functional Outcome

Femoral Fractures

Michael Kelly MD — 2005-09-04 23:42:33 GMT

Medscape 2000 Report from the Vail Orthopaedics Symposium features
1. Indirect Reduction of the Femur
2. Retrograde and antegrade nailing
3. Supracondylar Femur Fractures
4. Current Treatment of Femoral Neck Fractures
5. Current Technique: Use of Hemiarthroplasty in Femoral Neck Fractures
6. Classification and Treatment of Intertrochanteric Fractures

Femoral Neck Fractures in Young Adults

Philip R. Wolinsky, MD — 2002-04-27 23:42:33 GMT

Femoral neck fractures in the young adult are a different type of fracture than those seen in the elderly. These younger patients have normal bone density. A simple fall is not going to break the femoral neck. These fractures require high energy type injury mechanisms, and greater than 50% of the patients will have associated injuries as a reflection of the severity of their injury. The mechanisms is usually an axial load to the lower extremity with an abducted hip. The fracture pattern in these patients tends to be more vertical than in the elderly patient.
OTA Basic Fracture Course

Femoral Neck Stress and Insufficiency Fractures eMedicine Orthopedics

Wildstein & Schutte — 2008-03-19 23:42:33 GMT

Wildstein & Schutte 2007
Femoral neck stress fractures are a common cause of hip pain in select populations. Chronic, repetitive activity that is common to runners and military recruits predisposes these populations to femoral neck stress fractures. These injuries must be differentiated from insufficiency fractures, which, although similar in appearance and presentation, result from an entirely different pathophysiology and occur in a different population.
Synonyms and related keywords: fatigue fracture, insufficiency fracture, pseudofracture, exhaustion fracture, Deutschl�nder's fracture, Deutschl�nder fracture, Deutschlander's fracture, Deutschlander fracture, spontaneous fracture, march fracture, hip pain

Fractures of the Femoral Neck Wheeless

C.R.Wheeless — 2002-02-04 23:42:33 GMT

Extensive Menu on this subject - topics -
Work Up: anesthesia, medical considerations, and timing of surgery - X-rays for Femoral Neck Frx - Operative Techniques: Cannulated Screws: Sliding Hip Screws for Femoral Neck Frx Hemiarthroplasty Open Reduction of Femoral Neck Fracture: Anesthesia and Timing for Femoral Neck Fractures: Antibiotic Prophylaxis Anterolateral Approach Avascular Necrosis following Femoral Neck Fracture: Basilar Neck Frx Blood Supply Calcar Femorale: Capsule Closed Reduction Dislocations and Frx of the Hip Femoral Shaft Fracture Garden's Alignment Index/Eval. of Reduction Garden Classification: types I & II & types III & IV Intertrochanteric Fractures Nail Placement and Depth Non-Union Osteoporosis, Postmenopausal Pathologic Hip Fractures: Pediatric Hip Fractures Radiology of the Hip: Reduction of Femoral Neck Fracture: Singh index Stress Fractures of Femoral Neck: Subtrochanteric frx Thromboembolic Phenomena in Hip Frx and Surgery: Total Hip Arthroplasty Watson Jones Approach to the Hip Joint X-rays for Femoral Neck Fractures:

Garden I II Hip Fractures Wheeless

C.R.Wheeless — 2002-02-04 23:42:33 GMT

Garden I & II: Diagnosis and Treatment
Garden I:
- incomplete or impacted fracture, in which the trabeculae of the inferior neck are still intact;
- femoral head is tilted in a posterolateral direction, causing vaglus angulation at the frx site;
Garden II:
- complete frx w/o displacement (as opposed to stress frx)
- wt bearing trabeculae are interrupted by a frx line across entire femoral neck;
- is distinguished from impacted frx by slight varus deformity
Wheeless' Textbook of Orthopaedics

Garden III and IV Hip Fractures Wheeless

C.R.Wheeless — 2002-02-04 23:42:33 GMT

Garden III
complete fracture with partial displacement;
- "if it needs a reduction, then its a type III fracture;"
- frequently there is shortening and external rotation of distal frag;
- retinaculum of Weitbrecht remains attached to, & maintains continuity between, the proximal and distal fragments;
- trabecular pattern of femoral head does not line up w/ those of acetabulum, demonstrating incomplete displacement between femoral fragments;
Garden IV
- complete fracture w/ total displacement (some authors feel that the degree of displacement between Garden III and IV fractures is not significant);
- no continuity between proximal and distal fragments;
- femoral head assumes its normal position with in the acetabulum, and therefore the trabecular patterns of the acetabulum and the femoral head are aligned;
Wheeless' Textbook of Orthopaedics

Gardens Alignment Index Wheeless

C.R.Wheeless — 2002-02-04 23:42:33 GMT

refers to the angle of the compression trabeculae on AP view relative to the longintudinal axis of the femoral shaft and the angle of the compression trabeculae on the lateral view relative to the femoral shaft;
- on the AP this angle should be 160 deg vs 180 deg on the lateral;
Wheeless' Textbook of Orthopaedics

Hemiarthroplasty of the Hip Wheeless

C.R.Wheeless — 2002-02-04 23:42:33 GMT

indications: indicated for patients w/ a femoral neck frx who meet the following criteria:
- poor general health thay would prevent a second operation;
- pathologic hip fractures:
- parkinson's disease, hemiplegia, or other neurological disease;
- physiologic age > 70 yrs;
- severe osteoporosis w/ loss of primary trabeclae in femoral head (see Singh Index);
- inadequate closed reduction;
- displaced frx which is several days old;
- pre-existing hip disease (DJD, RA, AVN);
Wheeless' Textbook of Orthopaedics

Hip Capsule Wheeless

C.R.Wheeeless — 2002-02-04 23:42:33 GMT

Discussion of the anatomy of the hip capsule and its significance in femoral neck fractures.
Wheeless' Textbook of Orthopaedics

Internal fixation of intracapsular fractures

Parker & Tagg — 2008-09-09 23:42:33 GMT

The main indications for internal fixation of intracapsular fractures are undisplaced and minimally displaced fractures and displaced intracapsular fractures in those aged less than about 70 years. For displaced fractures, closed reduction is to be preferred to open reduction. Numerous different implants may have to be used; with current practice favouring two or three parallel cannulated cancellous screws. These may be inserted either percutaneously or with minimal surgical exposure. Attention to surgical details of fracture reduction and implant positioning will minimise the risk of fracture healing complications. Postoperative care should generally be unrestricted mobilization with weight bearing as tolerated.
M J Parker and CE Tagg Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, PE3 6DA, UK J.R.Coll.Surg.Edinb., 47, June 2002, 541-547

Locking Screw Compression Hip Screw

Hanna — 2005-09-05 23:42:33 GMT

Locking-Screw Compression Hip Screw for use with Retrograde Intramedullary Nailing in the Treatment of Ipsilateral Femoral Neck and Shaft Fractures Mark W. Hanna, MD 2003 Annual Meeting Georgia Orthopaedic Society

Operative Techniques for Hip Fracture Pins Wheeless

C.R.Wheeless — 2002-02-04 23:42:33 GMT

- if bone is dense enough to permit stable fixation, patients treated by percutaneous pinning have the advantage of immediate, full weight bearing postoperatively;
- failures in percutaneous pinning include AVN, non-union, failure of reduction, & late segmental collapse;
- options for treating these failures include conversion to hemiarthroplasty or total arthroplasty
Wheeless' Textbook of Orthopaedics

Regional Nerve Block in Fractured Neck of Femur

Bruce Martin — 2002-04-29 23:42:33 GMT

Meta-analysis of 27 papers on Regional Nerve Block in Fractured Neck of Femura. Conclusion: In patients with suspected fractured neck of femur, regional nerve block may be of benefit in reducing parenteral analgesic requirements.
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