Fractures of the femoral neck 股骨颈骨折

FracturesofthefemoralneckLiuFengNanjingMedicalUniversityTerminologyFemur—股骨Femoralneck—股骨颈Asepticnecrosis—无菌性坏死Non-union—不愈合Tensiletrabeculae—张力性骨小梁Compressivetrabeculae压力性骨小梁Reduction—复位Periosteum—骨外膜Totalhipreplacement—全髋关节置换Hipprosthesis—髋假体TheMainFeaturesoftheFemoralNeckFractureEspeciallycommoninelderlypeopleMorefrequentinwomenthanmen(osteoporosis)Theincidenceisincreasinginyoungpatients(industryinjury)Themostcommoncomplicationsarenon-unionandavascularnecrosisHaveatremendousimpactonhealthcaresystemandsocietyFraughtwithcomplications,thefractureisamongthemosttroublesomeandproblematicalfracturesThemortality(死亡率)afterthisfractureisashighas30%AnatomyoftheFemoralNeckThenormalshaft-neckangle:127127:valgusdeformity127:varusdeformityAnatomyoftheFemoralNeck---AnteriortiltangleAnatomyloadWhydowediscussthenormalanatomy?ToensurethecorrectreductionandfixationofthefractureVascularAnatomyThefovealartery:obturatorarteryTheascendingbranchesfromthenutrientarteryOnlysupplysmallpartsofbloodtotheheadTheextracapsulararterialring----theintracapsularringthemainvesselstothehead----2/3-3/5LateralfemoralcircumflexarteryMedialfemoralcircumflexarteryProfundasfemoralarteryMechanismofInjuryThefirst:afallproducingadirectblowoverthegreattrochanterThesecond:lateralrotationoftheextremityMostcommoninelderlywomenTheinjuryisminorortrivialInyoungpatients:majortraumaresultinginadirectforcealongtheshaftofthefemur---industryinjuryorcaraccidentClassifications:AnatomicLocationSubcapitalfracture:themostcommonTranscervicalfracture:rareBasilarfractureWhydowediscusstheclassifications?Garden’sClassification-DisplacementMostpopularclassificationTypeITypeIITypeIIITypeIVDiagnosisoftheFractureThehistory---fallPaininthegroinUnabletogetuporwalkExternalrotationofthelowerextremity(45O)ShorteningoftheaffectedlegEffortstomovethelegtoelicitcrepitusarecondemnableTreatmentoftheFracture---unsolvedfractureChallenges:TheintrinsicinstabilityofthefractureTheosteoporoticboneisnotsuitedtoholdingmetallicdeviceNoperiosteum---dependingentirelyontheendostealcallusPrecariousbloodsupplytotheheadTheMainApproachesfortheTreatmentClosedreductionandinternalfixationHipprosthesisConsiderationsforthechoiceTheageofthepatientThequalityoftheboneThetypeofthefracture---subcapital?,whattypeinGardens?ThegeneralhealthconditionsTheeconomicalconditionsofthefamilyWhomakethelastdecision?ClosedreductionandinternalfixationAdvantagesLesstraumaLessoperationdurationLessbloodlossLessmoneyDisadvantagesMoreimmobilizationMoreasepticnecrosisMorefracturenonunionMorecomplicationsforlongtimebedstayTotalhipreplacementAdvantagesImmediatemobilizationLesscomplicationswithimmobilizationImmediatebacktofamilyandsocietySelf-careabilityDisadvantagesMoretraumaMorebloodloss—transfusionMoremoneyatthismomentLimitedhipfunctionRelativemorecomplicationsaftersurgeryDecision-MakingFlowChartMorethan75yLessthan75yHipreplacementGoodboneBadboneBadgeneralheathgoodgeneralheathInternalfixationClosedreductionandinternalfixationTotalHipReplacementBeforesurgeryAftersurgeryTwoMainComplicationsAsepticnecrosisNon-UnionCommoninelderlywomenwithassociateddiseasesMaindeformity:shortingandexternalrotationClassifications:accordingtofracturesiteandthemagnitudeofdisplacementTreatment:CRIForTHATwomaincomplications:asepticnecrosisandnon-unionThisfractureisstillunsolvedSummaryThanksforYourAttentionIfyouhaveanyquestion:Feelfreetocontactmeat:[e-mail]13915981848