- 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)
Fractures Around The Hip Joint
Blood Supply of Proximal Femur
Proximal Femur Regions
Proximal Femur Fracture Types
Pipkin Classification for Femur Head Fractures
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.
