Hip fracture (proximal femur fracture)

1. Hip fracture(proximal femur fracture)

2. 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

3. Mechanism A simple fall ( 90 %)

4. 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

5. Treatment principles • Early mobilization, prevent decubiti, atalectasis,UTI.thrombophlebitis • Surgery within 24 hours • To walk within 2 weeks after surgery

6. Classification • Femeral neck fracture • Intertrochanteric fracture • Subtrochanteric fracture

8. 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

13. Femeral neck fracture

14. General considerations • Intracapsular fracture • Not covered by periosteum; no callus formation • Endosteal healing

15. 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

17. 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 orbone scan may be needed

18. Diagnosis Displaced fractures a.Shortened or externally rotated extremity b.AP and lateral x-ray reveal changed neck-shaft angle

23. Treatment Non-displaced fractures • Knowles pins or Cannulated screws • nonweight-bearing for 3 months

26. 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

29. Complicationsnon-union and avascular necrosis

30. Intertrochanteric fractures

31. General considerations • Exuracapsular fracture with better healing potential • Age:10 years older than femoral neck fracture

32. 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

35. Stability of fracture • Integrity of the posteromedial cortex is the most important factor • Reverse fracture is more unstable • Subtrochanter fracture is more unstable

39. Treament • Stable fractures: Close reduction with DHS(Dynamic hip screw) • Unstable fractures: Close reduction Gamma-nail(Small lever arm)

46. Complications Less non-union or avascular necrosis Malunion happened in unstable fractures

47. Thank you ( 3q )