Fractures Around The Hip Joint

Blood Supply of Proximal Femur

Proximal Femur Regions

Proximal Femur Fracture Types

Pipkin Classification for Femur Head Fractures

Type Ⅰ: Fracture below fovea (does not involve weight bearing area)
Type Ⅱ: Fracture above fovea (involves weight bearing area)
Type Ⅲ: Type Ⅰ or Type Ⅱ with associated femoral neck fracture
Type Ⅳ: Type Ⅰ or Type Ⅱ with associated acetabulum fracture (usually posterior wall)

Surgery Screw Fixation for Head of Femur Fractures

Surgery Screw Fixation for Head of Femur Fractures and Fixation of Associated Fractures

Garden Classification for Neck of Femur (NOF) fractures

Type Ⅰ: Incomplete valgus impacted
Type Ⅱ: Complete, non-displaced
Type Ⅲ: Complete, incompletely displaced
Type Ⅳ: Complete, completely displaced

Pauwels Classification for Neck of Femur fractures

Type Ⅰ: Angle subtended by horizontal & fracture on AP radiograph <30°
Type Ⅱ: Angle subtended by horizontal & fracture on AP radiograph is between 30° & 50°
Type Ⅲ: Angle subtended by horizontal & fracture on AP radiograph ≥50°

Surgery Considerations for Neck of Femur Fractures

Screw fixation
Dynamic hip screw fixation
Hip arthroplasty: Total hip arthroplasty or hemi-arthroplasty

Surgery Screw Fixation for Neck of Femur Fractures

Nondisplaced transcervical
Garden Ⅰ/Ⅱ
Young person with displaced NOF fracture requires urgent reduction and internal fixation

Screw fixation:

Start with inferior screw along calcar followed by Posterior superior screw and then Anterior superior. A 4th screw considered for posterior fracture comminution.

Hip Arthroplasty for Neck of Femur Fractures

Older patient with Garden Ⅲ/Ⅳ
Pre-existing hip arthritis
Total hip arthroplasty versus hemiarthroplasty considered for <85yrs and/or no comorbidities

Left total hip replacement with ceramic femoral head

Left total hip replacement with metal femoral head

Download ASSIC Performance Fingerprint or Strength & Conditioning apps for post hip replacement guideline rehab routine

Hip Replacement Surgery Technique after Neck of Femur Fracture

Post Hip Replacement Complications

Outcome

1-year mortality after a hip neck fracture is 20-30%

Pertrochanteric Fracture

Surgery Fixation for Pertrochanteric Fractures

Pertrochanteric fractures can be managed with Dynamic hip screw fixation

Intertrochanteric fracture

Evans Intertrochanteric Fracture Classification

AO Classification of Intertrochanteric Fractures

Surgery Fixation for Intertrochanteric Fractures

Stable Intertrochanteric fractures require Dynamic hip screw fixation

Tip apex distance (TAD)

Tip apex distance >25 mm has an increased risk of implant failure
Risk of implant failure is associated with:

Increased TAD> 25mm
Osteopaenia
Advanced age
Varus malalignment

The sum of the distances from the centre of femur head to tip of the screw on AP
and lateral X-rays views

Surgery Fixation for Unstable/Reverse Obliquity Intertrochanteric Fracture

Unstable intertrochanteric fractures (reverse obliquity or segmental base configuration) require Nail and screw fixation

Authors choice long nail and screw fixation

Subtrochanteric Fracture

Surgery Fixation for Subtrochanteric Fractures

Subtrochanteric fractures are managed with Nail and screw fixation

References

Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O’Brian LA, Hoffman S, Kaplan F. Risk factors for falls as a cause of hip fractures in women. The Northeast Hip Fracture Study Group. Engl J Med. 1991;324: 324-1331.
Management of acute hip fracture. Bhandari M, Swiontkowski M. N Engl J Med. 2017 Nov 23;377(21): 2053-2062.
Hip fracture: diagnosis, treatment, and secondary prevention. LeBlanc KE, Muncie HL Jr, LeBlanc LL. Am Fam Physician. 2014 Jun 15;89(12): 945-51.

Contributor:

Prof S Maqungo

Learn More