Osteosynthesis of Adult Fracture Neck of Femur and Femoral Neck System
DNB Orthopaedics • October 2024 • Paper IV • 10 Marks
Introduction
Fracture neck of femur is an intracapsular fracture with a significant risk of nonunion and avascular necrosis (AVN) because of disruption of the femoral-head blood supply.
In physiologically young adults, the principal treatment goal is preservation of the native femoral head by accurate reduction and stable internal fixation.
Fundamental principle
Good reduction is more important than the choice of implant. A poorly reduced femoral-neck fracture fixed with an excellent implant still has a high risk of failure.
Indications for Osteosynthesis
- Young and physiologically active adult
- Undisplaced or minimally displaced fracture in suitable patients
- Displaced fracture in young adult where femoral-head preservation is desired
- Good-quality femoral head without pre-existing advanced arthritis
- Patient in whom arthroplasty is not appropriate
In elderly patients with a displaced intracapsular fracture, arthroplasty is frequently preferred over osteosynthesis because of the higher risks of fixation failure, nonunion and AVN.
Factors Determining Choice of Fixation
- Age and physiological status
- Garden displacement
- Pauwels angle / fracture verticality
- Posterior comminution
- Bone quality
- Time from injury
- Reduction quality
- Associated ipsilateral injuries
Reduction Before Osteosynthesis
Displaced fractures require anatomical…