The Hip: Preservation, Replacement and Revision

IM Nailing and Sliding Screw Fixation of Femoral Neck Fractures:


- See:  Femoral Neck Frx

- IM Nailing of Femoral Neck Fractures:
      - closed reduction technique:
      - TFN nail
      - references:
              - Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques.
              - Vertical shear fractures of the femoral neck. A biomechanical study.
              - Basicervical fractures of the proximal femur. A biomechanical study of 3 internal fixation techniques.
              - Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. [see comment]
              - Is Pauwels classification still valid?
              - Fixation of displaced femoral neck fractures in young adults: Fixed-angle devices or Pauwel screws?

- Sliding Hip Screw: (for basilar neck fractures)
    - Sliding Screw Insertion Technique
    - surgeons will often elect to insert a sliding hip screw along with a single cannulated screw;
    - motivation for the addition of a cannulated screw is to prevent rotation of the proximal fragment;
    - problem w/ this type of fixation is that the cannulated screw will prevent fracture impaction and may lead to fracture non union;
    - in the following example, the reduction is not optimal and the cannulated screw may prevent further fracture impaction;
    - hemiarthroplasty:
          - may be indicated for some patients w/ basilar neck fractures, but often it is not the surgeon's first choice due to the risk of joint sepsis;

         

 Complications:
    - non union (20-25%)
    - avasulcar necrosis (25%);

- Case Example:
    - 45-year-old female w/ osteomalacia due to Sheenan's syndrome sustained a femoral neck fracture which was treated w/ a compression hip screw;
          - once the patient progressed w/ weight bearing, the hardware cut out superiorly and the fracture went on to non union;

                   

    - 70 year old demented male w/ comminuted basilar neck frx.  The frx was most stable in retroversion, and therefore a "stable" malreduction was accepted (w/ no apparent failure)

                    



Tips of the Trade #14. A guide for the proper placement of a above a cannulated Asnis screw above a sliding DHS hip screw.

Fixation of displaced femoral neck fractures. A comparison between sliding screw plate and four cancellous bone screws.

Internal fixation of femoral neck fracture. No difference between the Rydell four- flanged nail and Gouffon's pins.

Treatment of femoral neck fractures with the sliding compression screw.

Compression screw fixation for displaced subcapital fracture of the femur. Success or failure?

Unstable femoral neck fractures in young adults: treatment with the AO 130-degree blade plate.

Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques

Surgical treatment of basicervical fractures of femur--a prospective evaluation of 269 patients.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, August 26, 2016 11:56 am