Femoral Neck Fractures (Subscribe)

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Avoiding Missed Femoral Neck Fractures

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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

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Comminuted Lower-Extremity Fractures Secondary to Trauma

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

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Dedicated orthopedic trauma theatres

We performed a retro- spective review comparing morbidity and mortality outcomes at a single institution before and after the establishment of a dedicated trauma room. The purpose was to determine whether a change in outcomes occurred for a single routine procedure with known outcome expectations (hemiarthroplasty of the hip after femoral neck fracture) with the implementation of a designated trauma theatre.
Conclusion:The hip fracture population can be treated safely in the context of dedi- cated trauma room time; however, there needs to be prioritization of hip fractures in a tertiary care centre or other trauma cases will tend to take precedence.
Lemos et al 2009 Can J Surg, Vol. 52, No. 2, April 2009 89

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Femoral Fractures

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

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Femoral Neck Fractures in Young Adults

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

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Femoral Neck Stress and Insufficiency Fractures eMedicine Orthopedics

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, Deutschländer's fracture, Deutschländer fracture, Deutschlander's fracture, Deutschlander fracture, spontaneous fracture, march fracture, hip pain

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Fractures of the Femoral Neck Wheeless

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:

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Functional outcome of modified Pauwels’ intertrochanteric osteotomy and total hip arthroplasty in femoral neck fractures in elderly patients

Functional results of total hip arthroplasty and intertrochanteric osteotomy are comparable and the valgus intertrochanteric osteotomy with osteosynthesis in subcapital femoral neck fractures in elderly patients of sixty years and above may be considered as an option.
Indian J Orthop. 2008 Jan–Mar; 42(1): 49–55. Full text.
Functional outcome of modified Pauwels’ intertrochanteric osteotomy and total hip arthroplasty in femoral neck fractures in elderly patients Narender K Magu, Rochak Tater, Rajesh Rohilla, Ashish Gulia, Roop Singh, and Pardeep Kamboj

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Garden I II Hip Fractures Wheeless

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

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Garden III and IV Hip Fractures Wheeless

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

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Gardens Alignment Index Wheeless

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

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Hemiarthroplasty of the Hip Wheeless

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

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Hip Capsule Wheeless

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

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Locking Screw Compression Hip Screw

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

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Management of Pathological Fracture Neck of the Femur Following Recent Osteomyelitis in a Child

Singapore Med J 2002 Vol 43(4) : 205-207
Management of Pathological Fracture Neck of the Femur Following Recent Osteomyelitis in a Child A S Devnani
ABSTRACT Fracture neck of the femur is rare in children and occurs following severe trauma(1-5). Several recommendations have been made for the treatment of displaced transcervical fracture type II (Delbet classification)(1,2,5-8). However there are no recommendations when such a fracture occurs after recent acute osteomyelits of the neck of the femur. The management of a case is described with the outcome after 36 months.

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