Lesser the angulation more stable the fracture with a better a prognosis. Coronal CT images demonstrate the presence of an impacted fracture in the subcapital region of the left femur. Pauwel classification is based on post-reduction angulation of fracture line to the horizontal evaluated on a AP radiograph. type IV: complete, unstable and fully displaced.type III: complete, unstable and partially displaced.type II: complete, stable and undisplaced.Complications of hip fractures include Osteonecrosis of the femoral head Fracture nonunion Osteoarthritis Complications are more common among older patients with a displaced femoral neck fracture. type I: is incomplete, stable and impacted Femoral neck (subcapital) Intertrochanteric Subtrochanteric Subcapital and intertrochanteric fractures are the most common types.Further, the displacement is graded as per the position of the principal (medial) compressive trabeculae. Conversely, femoral neck fractures in the young adult are less common and frequently the result of high. Diagnosis is made with orthogonal radiographs of the shoulder. If a femoral neck fracture is not displaced, the most common treatment is. Such an injury is typically a fragility fracture 2. Summary Proximal humerus fractures are common fractures often seen in older patients with osteoporotic bone following a ground-level fall on an outstretched arm. Garden classification is based on the pre-reduction displacement of the femoral head. This type of fracture is also sometimes called a subcapital or intracapsular fracture. ClassificationĪlthough many classifications are proposed Garden classification and Pauwel classification are generally followed from a practical point of view as these two systems take into consideration the stability of the fractures. The fracture line extends through the junction of the head and neck of femur. B2) are unstable and can come along with a rotation of the humeral head. In the cognitively dysfunctional, a bipolar hemiarthroplasty or a total hip arthroplasty with use of larger heads (32 mm or 36 mm) and/or constrained sockets are a viable option.Subcapital fracture is the most common type of intracapsular neck of femur fracture. Non-impacted subcapital fracture with avulsion of one of the tuberosities (AO group. For those who are cognitively functioning, total hip arthroplasty appears to be the best option. Otremski I, Katz A, Dekel S, Salama R, Newman RJ (1990) Natural history of impacted subcapital femoral fractures and its relevance to treatment options. For displaced femoral neck fractures in the elderly, cognitive function should be determined. The younger patient should be treated with urgent ORIF with the goal of an anatomic reduction. For displaced femoral neck fractures, the treatment differs depending on the age of the patient. Non-displaced fractures, regardless of age of the patient, should be treated with closed reduction and internal fixation. Subcapital fracture is the commonest type of intracapsular fracture of the proximal femur. In younger patients with dense cancellous bone, the cannulated tap may be necessary to precut the thread. Impacted subcapital fracture of left femoral neck. Then insert three 7.0 mm or 7.3 mm cannulated cancellous screws over the wires. A simple algorithm can be helpful in terms of directing the treatment. To prepare the path for the core diameter of the screws, drill over the wires with a 3.6 mm cannulated drill bit. Treatment options take in to consideration the patient's age, functional demands, and individual risk profile. Instead of a diagnosis-related approach, it has become more of a patient-related approach. More recently, the traditional paradigm has changed. Historically, the treatment option has been driven by a diagnosis-related approach (non-displaced neck fractures versus displaced neck fractures). Options for the treatment of subcapital femoral neck fractures basically fall into two categories: internal fixation or arthroplasty (either hemiarthroplasty or total hip arthroplasty).
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