- Closed Reduction
- X-rays for Femoral Neck Fractures
- 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.