NECK OF FEMUR FRACTURE

Question 1

AGE

Answer 1

ELDERLY ,
6TH 7TH DECADE

Question 2

MECHANISM

Answer 2

ELDERLY = TRIVAL TRAUMA
ADULTS= RTA
STRESS FRACTURE

Question 3

CLASSIFICATION

Answer 3

PAUWELS CLASSIFICATION
GARDENS CLASSIFICATION

Question 3

SEX

Answer 3

OSTEOPOROTIC FEMALE

Question 4

GARDENS CLASSIFICATION

Answer 4

BASED ON DEGREE OF ROTATIONAL DISPLACEMENT OF FRACTURE
STAGE 1 = INCOMPLETE FRACTURE , BENDING OF TRABECULAE SEEN
STAGE 2 = COMPLETE FRACTURE , PARTIAL DISPLACEMENT , BREAK IN TRABECUALE STREAM OF HEAD AND NECK
STAGE 3 = COMPLETE FRACTURE, PARTIAL DISPLACEMENT, ALL THREE SETS , THAT IS ACETABULAR , HEAD AND NECK TRABECULAE NOT ALIGNED.
STAGE 4 = COMPLETE FRACTURE , FULLY DISPLACED, HEAD AND NECK TRABECULAE NOT ALIGNED

Question 4

PAUWELS CLASSIFICATION

Answer 4

BASED ON ANGLE OF INCLINATION OF FRACTURE LINE IN RELATION TO HORIZONTAL LINE .
TYPE 1 - 30 DEGREE WITH HORIZONTAL LINE
TYPE 2 - 50 DEGREE WITH HORIZONTAL LINE
TYPE 3 - 70 DEGREE WITH HORIZONTAL LINE

Question 5

CLINICAL FEATURES

Answer 5

PAIN IN GROIN AN DINABILITY OF BEAR WEIGHT ( ELDERLY )
SWELLING
HISTORY OF TRAUMA
PATIENT MAY WALK TO OPD WHEN FRACTURE IMPACTED

Question 6

EXAMINATION

Answer 6

REVEALS
EXTERNAL ROTATION OF LEG
SLRT NOT POSSIBLE
SHORTENING OF LIMB
TENDERNESS IN GROIN

Question 7

IMAGING

Answer 7

SHENTONS LINE DISRUPTED
TRABECULAE STREAM DISRUPTED
GREATER TROCHANTER LIES ABOVE LEVEL OF HEAD
LESSER TROCHANTER MORE PROMINENT
BREAK IN MEDIAL CORTEX OF NECK

Question 8

LESS THAN 3 WEEKS

Answer 8

UNDISPLACED =
CHILDREN - HIP SPICA + SMOOTH PINS
ADULT = CANNULATED CANCELLOUS SCREWS

DISPLACED =
*PHYSIOLOGICALLY LESS THAN 60 -
CLOSED REDUCTION DONE UNDER X RAY CONTROL
IF REDUCED : FIXATION WITH CANNULATED CANCELLOUS SCREW OR DHS
IF NOT REDUCED : ORIF ( WITH CANNULATED CANCELLOUS SCREW , DHS , MOORES PIN OR KNOWLES PIN ( CHLDREN )

*PHYSIOLOGICALLY MORE THAN 60 -
PROSHETIC REPLACEMENT
HIP WITHOUT ARTHRITIS - HEMIARTHROPLASTY
WITH ARTHRITIS - TOTAL HIP REPLACEMENT

Question 9

TREATMENT

Answer 9

PATIENT PRESENTED LESS THAN 3 WEEKS
PATIENT PRESENTED MORE THAN 3 WEEKS

Question 10

IF PRESENTED MORE THAN 3 WEEKS

Answer 10

LESS THAN 60 YEARS -
BONE SCAN DONE
IF HEAD VASCULAR THEN PAUWELLS OSTEOTOMY OR MEYERS PROCEDURE
IF NOT VAASCULAR THEN BIPOLAR HEMIARTHROPLASTY

Question 11

COMPLICATION

Answer 11

NON UNION
AVN
OSTEOARTHRITIS