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Title: Fracture Neck Femur 1 Fracture Neck Femur • Dr.Sadeq Al-Mukhtar • Consultant Orthopaedic Surgeon 2 Epidemiology • 97 occurs in patients more than 50 years old. The incidence increases with age. • 3 occurs in under 50 years age(20-40) due to high energy trauma, sports, industrial motor vehicle accidents. In 20-40 years most hip fractures are subtrochanteric or basi- cervical.

Fractures in elderly are serious injuries, about 250,000 fractures per year in USA the number is projected to double by the year 2050 the cost exceeds 6 billion per year 3 Anatomy • The femoral side of the hip is made of the femoral head with its articular cartilage the femoral neck which connects the head to the shaft in the region of intertrochanteric area. The synovial membrane incorporates the entire head the anterior neck but only the middle part of the neck posterior.The neck shaft angle is 130(_7) degree. The Ante version is 10(_7). 4 • The diameter of femoral head ranges from 40-60 mm. The thickness of the articular cartilage ranges from 4mm in the apex to 1mm in the periphery. • Blood supply of the head from • 1- Artery of ligamentum teres that usually originates from anterior obturator artery but it supplies only small area of the head near the attachment of the ligament.

5 • 2- Lateral, medial, anterior posterior Capital vessels. • 3- Lateral, medial, anterior posterior cervical vessels. • All these 23 vessels groups comes from intertrochanteric ring. • Accumulation of intracapsular hematoma interferes with the venous outflow perhaps the vascular inflow. After 12 hours necrosis of the head starts. Vag Com 409.1 Deutsch here.

6 Biomechanics • Falling from standing position leads to direct blow on the greater trochanter. Osteoporosis is the precipitating factor. • In young middle aged high velocity trauma is needed to induce fracture. • Postmenopausal senile osteoporosis predisposes to fracture. Manuale Perfetto Arcanista 3.5 Pdf. By the age of 65 years, 50 of women show bone mineral content below the threshold for fracture. By the age of 85 year this will reaches 100 • In elderly it can occur with minor trauma on an externally rotated thigh or the bone is so weak that powerful muscle contraction can lead to fracture. 7 Classifications • 1- Anatomical classification • A- Intracapsular • Subcapital (high risk) • Tran cervical (moderate risk) • Basal (less risk) intracapsular anteriorly, extra capsular posteriorly. • Sometimes, high energy fracture occur in young which involve the shaft of femur then to the base of the neck then to the sub capital area.

Usually these are undisplaced. 8 • B- Extra-capsular • Inter-trochanteric fractures • Per-trochanteric • NotesIntracapsular fractures carry poor prognosis because of poor blood supply which lead to avascular necrosis non-union while extracapsular fractures carry good prognosis due to the good blood supply 9 • 2- Gardens classification • They are classified according to the degree of displacement of the fracture fragment. • 1- Incomplete fracture(abduction impacted) making the neck in valgus.