Dr. Ebraheim's animated educational video describes hip fracture types and the fixation.
This is a quick review of hip fracture types and its fixation.
Femoral neck fracture (subcapital fracture)
•High incidence of avascular necrosis (AVN) and nonunion.
•High mortality rate in the elderly.
Treatment:
oNondisplaced: pinning by cannulated screws for the young and elderly patients.
oDisplaced in young patients: open or closed reduction followed by pinning with cannulated screws.
oDisplaced in elderly people: prosthesis (bipolar, unipolar or total hip).
oIt is not advisable to do closed reduction and screw fixation in displaced subcapital fractures in the elderly.
Intertrochanteric fracture
Two types:
1-Regular :
•Reduction
•Compression hip screw
•Intramedullary nail (Long, short): if a long nail is used, make sure you do not perforate the anterior cortex of the distal femur.
2-Reverse oblique: affects the lateral cortex of the femur
Treatment:
•Intramedullary nail
•Blade plate
•Fixed angle plate
•IM rod: done in majority of cases
•Compression hip screw: do not use. Medial displacement of the fracture due to pull from the adductor muscles. Compression hip screw is not a suitable device for reverse oblique fractures.
Subtrochanteric fracture
•The fracture line extends distally to the lesser trochanter
•High-stress load
•Common occurrence of nonunion
•The subtrochanteric region has a hard cortical bone that does not heal very well.
Treatment:
•Intramedullary nail
•Compression hip screw: not commonly used, higher chance of nonunion.
•You may want to do this case closed in order to preserve the blood supply and the healing ability of the fracture.
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