Proximal femur fracture: Difference between revisions
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==Overview== | ==Overview== | ||
* <span style="line-height: 20px">Imaging</span> | |||
* Imaging | ** Consider AP pelvis in addition to standard AP and lateral views to compare to contralateral side | ||
* Consider AP pelvis in addition to standard AP and lateral views to compare to contralateral side | ** Consider MRI if strong clinical suspicion but negative xray | ||
* Consider MRI if strong clinical suspicion but negative xray | |||
* Most fractures, including all displaced fx, are treated with ORIF | * Most fractures, including all displaced fx, are treated with ORIF | ||
* Isolated trochanteric fx often does not require | ** Isolated trochanteric fx often does not require surgery� | ||
* Skeletal traction is not | * Skeletal traction is not beneficial� | ||
* Type and cross/screen for pts at higher risk of hemorrhage | * Type and cross/screen for pts at higher risk of hemorrhage | ||
* Age > 75 yrs | ** Age > 75 yrs | ||
* Initial hemoglobin < 12 | ** Initial hemoglobin < 12 | ||
* Peritrochanteric | ** Peritrochanteric fx� | ||
* Adolescent + knee or hip pain = rule-out | * Adolescent + knee or hip pain = rule-out SCFE� | ||
==Intracapsular== | ==Intracapsular== | ||
* ====Femoral Head==== | |||
** Usually occurs along with dislocation | |||
*** Posterior dislocation - Fracture of inf aspect of femoral head; concomitant sciatic nerve injury | |||
*** Anterior dislocation - Fracture of anterior femoral head; concomitant vascular injury | |||
* Femoral | * ====Femoral neck==== | ||
* | ** Typically minimal bruising (intracapsular) | ||
** If fractured and displaced: | |||
*** Externally rotated and shortened | |||
* | ** Garden Classification | ||
* | *** Type 1: Impaction Fx | ||
*** Type 2: Nondisplaced Fx� | |||
*** Type 3: Displacement of the femoral head | |||
*** Type 4: Complete loss of continuity between fragments<span style="line-height: 20px"><br /></span> | |||
==Extracapsular== | ==Extracapsular== | ||
* ====Intertrochanteric==== | |||
* Intertrochanteric | ** Typically pain, swelling, ecchymosis | ||
* Typically pain, swelling, ecchymosis | *** May lose 1-2L of blood | ||
* May lose 1-2L of blood | ** Unable to bear weight | ||
* Unable to bear weight | ** Shortening and external rotation if fracture is significantly displaced� | ||
* Shortening and external rotation if fracture is significantly | ** Types | ||
* Types | *** Stable - Lesser trochanter is not displaced, no comminution, medial cortices of prox and dist. fragments are aligned | ||
* Stable - Lesser trochanter is not displaced, no comminution, medial cortices of prox and dist. fragments are aligned | *** Unstable - Displacement occurs, comminution is present, or multiple fracture lines exist | ||
* Unstable - Displacement occurs, comminution is present, or multiple fracture lines exist | * ====<span style="line-height: 20px">Trochanteric</span>==== | ||
* Trochanteric | ** '''Lesser Trochanter''' | ||
* Lesser Trochanter | *** Pain in groin or�<span style="line-height: 20px">may present with knee or posterior thigh pain worse with hip flexion and rotation</span> | ||
* Pain in groin | *** Most common in the young (due to forceful contraction of iliopsoas muscle) | ||
* Most common in the young (due to forceful contraction of iliopsoas muscle) | **** If occurs in elderly pt with lack of trauma history consider lytic lesion�<span style="line-height: 20px">�</span><span style="line-height: 20px">�</span> | ||
* If occurs in elderly pt with lack of trauma history consider lytic | ** '''Greater Trochanter''' | ||
* Greater Trochanter | *** Hip pain that increases with abduction and tenderness over the greater trochanter | ||
* Hip pain that increases with abduction and tenderness over the greater trochanter | ** Imaging | ||
* Imaging | *** Lessor trochanter - �AP view with the leg in supported external rotation | ||
* Lessor trochanter - | *** Greater trochanter - Standard AP view | ||
* Greater trochanter - Standard AP view | ** Treatment<span style="line-height: 20px">�</span> | ||
* Treatment | *** NWB for 3-4 weeks for non-displaced fx | ||
* NWB for 3-4 weeks for non-displaced fx | *** If displaced (> 1cm) refer to orthopedic surgeon for ORIF | ||
* If displaced (> 1cm) refer to orthopedic surgeon for ORIF | * ====Subtrochanteric (including mid-shaft)==== | ||
* Subtrochanteric (including mid-shaft) | ** Occur with severe trauma or in association with pathological bone | ||
* Occur with severe trauma or in association with pathological bone | *** Blood loss can be substantial (average loss = 1L) | ||
** Clinical presentation is similar to intertrochanteric fracture | |||
* Blood loss can be substantial (average loss = 1L) | |||
* Clinical presentation is similar to intertrochanteric fracture | |||
Source: UpToDate, Harwood-Nuss | Source: UpToDate, Harwood-Nuss | ||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 21:56, 8 April 2011
Overview
- Imaging
- Consider AP pelvis in addition to standard AP and lateral views to compare to contralateral side
- Consider MRI if strong clinical suspicion but negative xray
- Most fractures, including all displaced fx, are treated with ORIF
- Isolated trochanteric fx often does not require surgery�
- Skeletal traction is not beneficial�
- Type and cross/screen for pts at higher risk of hemorrhage
- Age > 75 yrs
- Initial hemoglobin < 12
- Peritrochanteric fx�
- Adolescent + knee or hip pain = rule-out SCFE�
Intracapsular
- ====Femoral Head====
- Usually occurs along with dislocation
- Posterior dislocation - Fracture of inf aspect of femoral head; concomitant sciatic nerve injury
- Anterior dislocation - Fracture of anterior femoral head; concomitant vascular injury
- Usually occurs along with dislocation
- ====Femoral neck====
- Typically minimal bruising (intracapsular)
- If fractured and displaced:
- Externally rotated and shortened
- Garden Classification
- Type 1: Impaction Fx
- Type 2: Nondisplaced Fx�
- Type 3: Displacement of the femoral head
- Type 4: Complete loss of continuity between fragments
Extracapsular
- ====Intertrochanteric====
- Typically pain, swelling, ecchymosis
- May lose 1-2L of blood
- Unable to bear weight
- Shortening and external rotation if fracture is significantly displaced�
- Types
- Stable - Lesser trochanter is not displaced, no comminution, medial cortices of prox and dist. fragments are aligned
- Unstable - Displacement occurs, comminution is present, or multiple fracture lines exist
- Typically pain, swelling, ecchymosis
- ====Trochanteric====
- Lesser Trochanter
- Pain in groin or�may present with knee or posterior thigh pain worse with hip flexion and rotation
- Most common in the young (due to forceful contraction of iliopsoas muscle)
- If occurs in elderly pt with lack of trauma history consider lytic lesion���
- Greater Trochanter
- Hip pain that increases with abduction and tenderness over the greater trochanter
- Imaging
- Lessor trochanter - �AP view with the leg in supported external rotation
- Greater trochanter - Standard AP view
- Treatment�
- NWB for 3-4 weeks for non-displaced fx
- If displaced (> 1cm) refer to orthopedic surgeon for ORIF
- Lesser Trochanter
- ====Subtrochanteric (including mid-shaft)====
- Occur with severe trauma or in association with pathological bone
- Blood loss can be substantial (average loss = 1L)
- Clinical presentation is similar to intertrochanteric fracture
- Occur with severe trauma or in association with pathological bone
Source: UpToDate, Harwood-Nuss