Femoral Neck fracture Classifications - Everything You Need To Know - Dr. Nabil Ebraheim скачать в хорошем качестве

Femoral Neck fracture Classifications - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes fracture classifications of the femoral neck. Garden classification Type I Incomplete and impacted in valgus Type II Fracture is complete and nondisplaced on at least two planes (anterior & lateral). Type III Complete fracture and partially displaced Trabecular pattern of the femoral head does not line up with the acetabular trabecular pattern. Type IV Completely displaced with no continuity between the proximal and distal fragments Pauwel’s classification There are three fracture types within Pauwel’s classification: Type I Type I has an obliquity ranging from 0 to 30 degrees. Type II Type II has an obliquity ranging from 30 to 50 degrees Type III Type III has an obliquity of 70 or more degrees. The more vertical orientation of the fracture, the higher the risk of nonunion and osteonecrosis. The more displaced the fracture, the more disruption of the blood supply and chance of avascular necrosis and nonunion. Avascular necrosis may occur in 20-25% of displaced fractures. Nonunion may occur in about 25% of displaced fractures. Treatment Nondisplaced fracture Screw fixation Nondisplaced fracture may become displaced Important to fix the fracture emergently in young patients before the fracture becomes displaced. Displaced fracture-younger patients EMERGENCY Do closed reduction and screw fixation If closed reduction fails, do open reduction and screw fixation utilizing the Watson Jones approach. Displaced fracture older patients Screw fixation in the elderly has a higher incidence in failure of fixation and reoperation. Do not do screw fixation. High functional demand patient Do total hip arthroplasty Total hip is the procedure of choice especially if there is pre-existing rheumatoid or degenerative arthritis. Higher dislocation rate. Elderly low demand patient Unipolar or bipolar Cemented or uncemented In rare cases, excision of the femoral head can provide alternative in high-risk patients. Nonunion Do subtrochanteric osteotomy in younger patients. Do prosthesis in older patients Become a friend on facebook:   / drebraheim   Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC