The Hip: Preservation, Replacement and Revision

Open Reduction of Femoral Neck Fracture


- 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.

Indications for open reduction of femoral neck fractures.

Open reduction of intracapsular hip fractures using a modified Smith-Petersen surgical exposure.

Biomechanical analysis of a novel femoral neck locking plate for treatment of vertical shear Pauwel's type C femoral neck fractures.





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

Last updated by Data Trace Staff on Thursday, September 13, 2012 4:27 pm