Replacing the femoral head is achieved with either hemiarthroplasty or total hip arthroplasty. Internal fixation can be performed with multiple pins (cannulated screws), intramedullary hip screw (IHMS), crossed screw-nails or compression with a dynamic screw and plate 9. The treatment options include non-operative management, internal fixation or prosthetic replacement. Significant complications such as avascular necrosis and non-union are very common without surgical intervention. Treatment of neck of femur fractures is important. Representing hemarthrosis in the context of an intra-articular fractureĮxpansion of the anterior synovial recess with separation of the anterior and posterior synovial reflections by a collection of variable echogenicity Long and short axis views of the femoral neck with the overlying anterior synovial recess, femoral head and acetabulum and the greater and lesser trochanters are obtained with the following features consistent with a femoral neck fracture:īreach in the normally smooth cortical surfaceĬommonly associated with a hypoechoic fluid collection representing hematoma 21 Point of care ultrasound may be utilized as an adjunct to radiography to facilitate timely diagnosis of femoral neck fractures and may be subsequently employed to deliver prompt relief of pain by delivery of a suitable nerve block (e.g. Non-displaced fractures may be subtle on x-rayĪP pelvis and lateral hip should be viewed because pelvic fractures can mimic clinical features of hip fractureĪssess for symmetry, particularly note lesser trochanter (may indicate external rotation) Lesser trochanter is more prominent due to external rotation of femurįemur often positioned in flexion and external rotation (due to unopposed iliopsoas) Shenton’s line disruption: loss of contour between normally continuous line from medial edge of femoral neck and inferior edge of the superior pubic ramus There is some evidence that thin-slice MDCT is as sensitive as MRI 19. In patients with a suspected occult NOF fracture, MRI (sensitivity 99-100%) is recommended by many institutions as the second-line test if available within 24 hours, with CT or nuclear medicine bone scan third-line 17,18. Plain radiograph (sensitivity 93-98%) is the first-line investigation for suspected NOF fractures. The mechanism in young patients is predominantly axial loading during high force trauma 9, with an abducted hip during injury causing a neck of femur fracture and an adducted hip causing a hip fracture-dislocation. There is generally deficient elastic resistance in the fractured bone 8. In elderly patients, the mechanism of injury varies from falls directly onto the hip to a twisting mechanism in which the patient’s foot is planted and the body rotates. motor vehicle collisions) in younger patients Subcapital fractures are graded by the Garden classification of hip fractures. While there is disagreement in the literature as to whether basicervical fractures are truly intracapsular or extracapsular, they should usually be treated like extracapsular fractures 14. Subcapital and transcervical fractures are considered intracapsular fractures. Transcervical: midportion of femoral neck Since disruption of blood supply to the femoral head is dependent on the type of fracture and causes significant morbidity, the diagnosis and classification of these fractures is important. Pathology Classificationįemoral neck fractures are a subset of proximal femoral fractures. The femoral neck is the weakest part of the femur. Hip fractures can be divided into intracapsular and extracapsular fractures with 60% being intracapsular and of that 80% are displaced 20. In patients aged between 65 and 99 years, femoral neck and intertrochanteric fractures occur with approximately the same frequency 7. The incidence of femoral neck fractures is increasing as the proportion of the elderly population in many countries increases 4.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |