- See:
-
Closed Reduction
-
X-rays for Femoral Neck Fractures:
- Indications:
- w/ failure to obtain a
closed reduction persists, esp in younger pt or older child, then open reduction is considered;
- Posterior Approach:
- in young pt requiring ORIF of a displaced femoral neck frx, consider
posterolateral approach in the lateral position;
- this allows visualization of posterior cortex during
reduction and allows soft tissue and periosteum to be removed from fracture site;
- visualization is less optimal compared w/
anteriolataeral approach;
- comminution can be assessed, and if bone grafting is indicated, posterior spine or greater trochanter can be used easily;
- if later reconstruction is indicated, posterior skin incision will usually be required, which prevents a second major scar;
- Watson-Jones Approach:
- straight lateral incision, which is extended proximally in interval between
tensor fasciae latae and
gluteus medius muscles;
- this interval is split bluntly down to anterior aspect of hip
capsule, & origin of vastus lateralis is elevated from intertroch ridge;
- hip capsule is split over femoral neck anteriorly & then is dissected off intertrochanteric ridge inferiorly and superiorly;
- visualize frx w/ appropriate retractors;
- use bone-hook to achieve reduction;
- hook is placed onto the greater trochanter and is used to disimpact frx;
- externally rotating hip may assist w/ frx disimpaction;
- internally rotate femur to achieve final reduction;;
- laterally, insert guide pins to hold reduction;
- insert cannulated screws;
Ununited femoral neck fractures by open reduction and vascularized iliac bone graft.
Ununited femoral neck fractures by open reduction and vascularized iliac bone graft.
Indications for open reduction of femoral neck fractures.
Open reduction of intracapsular hip fractures using a modified Smith-Petersen surgical exposure.
