Fractures of the femoral neck 股骨颈骨折

1、Fractures of the femoral neck,Liu Feng Nanjing Medical University,Terminology,Femur股骨 Femoral neck股骨颈 Aseptic necrosis无菌性坏死 Non-union不愈合 T ensile trabeculae张力性骨小梁 Compressive trabeculae压力性骨小梁 Reduction复位 Periosteum骨外膜 Total hip replacement全髋关节置换 Hip prosthesis髋假体,The Main Features of the Femoral Nec

2、k Fracture,Especially common in elderly people More frequent in women than men (osteoporosis) The incidence is increasing in young patients (industry injury) The most common complications are non-union and avascular necrosis Have a tremendous impact on health care system and society Fraught with com

3、plications, the fracture is among the most troublesome and problematical fractures The mortality (死亡率)after this fracture is as high as 30%,Anatomy of the Femoral Neck,The normal shaft-neck angle:127 127: valgus deformity 127:varus deformity,Anatomy of the Femoral Neck-Anterior tilt angle,Anatomy,lo

4、ad,Why do we discuss the normal anatomy?,To ensure the correct reduction and fixation of the fracture,Vascular Anatomy,The foveal artery: obturator artery The ascending branches from the nutrient artery Only supply small parts of blood to the head The extracapsular arterial ring-the intracapsular ri

5、ng the main vessels to the head-2/3-3/5,Lateral femoral circumflex artery,Medial femoral circumflex artery,Profundas femoral artery,Mechanism of Injury,The first: a fall producing a direct blow over the great trochanter,The second : lateral rotation of the extremity,Most common in elderly women The

6、injury is minor or trivial In young patients: major trauma resulting in a direct force along the shaft of the femur-industry injury or car accident,Classifications: Anatomic Location,Subcapital fracture:the most common,Transcervical fracture: rare,Basilar fracture,Why do we discuss the classificatio

7、ns?,Gardens Classification-Displacement,Most popular classification,Type I,Type II,Type III,Type IV,Diagnosis of the Fracture,The history-fall Pain in the groin Unable to get up or walk External rotation of the lower extremity (45O) Shortening of the affected leg,Efforts to move the leg to elicit cr

8、epitus are condemnable,Treatment of the Fracture- unsolved fracture,Challenges: The intrinsic instability of the fracture The osteoporotic bone is not suited to holding metallic device No periosteum-depending entirely on the endosteal callus Precarious blood supply to the head,The Main Approaches fo

9、r the Treatment,Closed reduction and internal fixation,Hip prosthesis,Considerations for the choice,The age of the patient The quality of the bone The type of the fracture-subcapital?,what type in Gardens? The general health conditions The economical conditions of the family Who make the last decisi

10、on?,Closed reduction and internal fixation,Advantages Less trauma Less operation duration Less blood loss Less money,Disadvantages More immobilization More aseptic necrosis More fracture nonunion More complications for long time bed stay,Total hip replacement,Advantages Immediate mobilization Less c

11、omplications with immobilization Immediate back to family and society Self-care ability,Disadvantages More trauma More blood losstransfusion More money at this moment Limited hip function Relative more complications after surgery,Decision-Making Flow Chart,More than 75y,Less than 75y,Hip replacement

12、,Good bone,Bad bone,Bad general heath,good general heath,Internal fixation,Closed reduction and internal fixation,Total Hip Replacement,Before surgery,After surgery,Two Main Complications,Aseptic necrosis,Non-Union,Common in elderly women with associated diseases Main deformity: shorting and external rotation Classifications: according to fracture site and the magnitude of displacement Treatment : CRIF