Femoral Neck Fractures

7/18/2019 Femoral Neck Fractures

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FEMORAL NECK

FRACTURES:Physiotherapy

ManagementDr. D. N. !DSar"a#ani$ Co%%ege o& Physiotherapy'

S(rat


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Defnition

A Femoral Neck # is a # occurringproximal to the intertrochanteric linein the intracapsular region o the hip.

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Classifcation

Pauwels [!"$ Angle %escri&es 'ertical shear 'ector


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Classifcation

(ar%en [!)$* +algus impacte% or

incomplete

** Complete

Non,%isplace%

*** Complete

Partial%isplacement

*+ Complete

Full %isplacement

-- Porten%s risk o A+N

an% Nonunion

I II

III IV


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Classifcation

Functional Classifcation

ta&le *mpacte% /(ar%en *0

Non,%isplace% /(ar%en **0

1nsta&le Displace% /(ar%en *** an% *+0


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Femora% ne)$ * )%assi+e, as -ar,enstype /: an in)omp%ete impa)te, &emora%ne)$ * in "a%g(s position. A%% &emora%ne)$ *s are intra)aps(%ar.

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-ar,ens type 0: non,isp%a)e,)omp%ete &emora% ne)$ *.


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-ar,ens type 1: ,isp%a)e, &emora% ne)$ * in "ar(sposition. There is o&ten ,isr(ption o& the #oint )aps(%e.

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-ar,ens type 2: )omp%ete%y ,isp%a)e, &emora% ne)$ *.!t has the poorest prognosis. The &emora% hea, may goon to A3N. !n o%,er patients' this * is (s(a%%y treate,4ith a en,oprosthesis.

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u&capital emoral neck # at the proximal en% othe neck. 4his # is %isplace% an% in 'arus position/(ar%en5s t6pe "0

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u&capital # o the emoral neck impacte%an% in 'algus position /(ar%en5s t6pe 0.


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8echanism o *n9ur6

8ost emoral neck # in the el%erl6 arespontaneous or cause% &6 low energ6 trauma.

4his population is su&9ect to senile osteoporosis

/t6pe **0: which causes weakness in &oth thecortical an% tra&ecular &one o the emoral neckan% pre%isposes it to #.

*n 6ounger patients: high energ6 trauma isnecessar6 to cause a emoral neck # : an%thereore %isplacement o the # an% %amage tothe &loo% suppl6 is usuall6 greater in those

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HIGH-ENERGY

INJURY

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LOW ENERGY INJURY

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4reatment (oals


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u&capital # o the emoralneck.

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Fracture fxe% with a screw an% si%e plate tocompress the # in an attempt to restore corticalan% cancellous contact.

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4o achie'e imme%iate sta&ilit6: the emoral hea%an% neck are replace% in an el%erl6 patient with anunsta&le #.

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=eha&ilitation


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=eha&ilitation most important or postop

sta&ilit6

*liopsoas

(luteus maximus

A%%uctor longus: magnus: &re'is

Bua%riceps> 'ast. lateralis is expose% %uringsurger6.

hamstrings

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=eha&ilitation


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@xpecte% time o Eone ealing

2,) weeks.

@xpecte% Duration o =eha&ilitation

,"7 weeks.

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8etho%s o 4reatment

Close%or


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M(%tip%e para%%e% )ann(%ate,s)re4 &or interna% +7ation o& a-ar,ens type / *. Fra)t(resthat are a,e8(ate%y re,()e, inpatients yo(nger than 9 yearso& age are treate, 4ith interna%+7ation in sit(.

Compression s)re4 an, s%i,e+7ation. This is an a%ternati"e tom(%tip%e para%%e% )ann(%ate,s)re4s. An a,,itiona% pro7ima%antirotationa% s)re4 may ;e(se, to pre"ent the %oose hea,&rom spinning on the s)re4.

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8etho%s o 4reatment Prosthetic =eplacement o Femoral ea%

iome)hani)s:tress &earing %e'ice.

Mo,e o& ;one hea%ing :None

!n,i)ations: A fxe% unipolar /Austin,8oore or 4hompson t6pe0 or

&ipolar en%oprosthesis ma6 &e use% to treat anunsta&le %isplace% # when a satisactor6 re%uction

cannot &e achie'e% an% the patient is ol%er that )6ears o age.


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Eipolar en%oprosthesis or treatment o an unsta&le%isplace% emoral neck #. 4his is reGuentl6 use% inpatients ol%er than ) 6ears o age whensatisactor6 re%uction cannot &e achie'e%.

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( % 5 ; l k


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(ar%en5s t6pe ;> emoral neck #:completel6 %isplace%: in an ol%erpatient.

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Eipolar en%oprosthesis replacement o the #e%emoral neck %uring the imme%iate postoperati'eperio%. Note the %rains an% staples in place.

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Spe)ia% )onsi,erations o&the Fra)t(re

igh rate o non,union

No periosteum in this areaH allhealing occurs through en%oosteum

# sites is &athe% &6 s6no'ial ui%I%issol'es the f&rin clot J retar%shealing.

D+4

Pulmonar6 em&olism J chest pain:shortness o &reath

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Associate% *n9uries

#s o wrist: shoul%er K ri&s etc.

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Leight Eearing

Depen%s on sta&ilit6 o the re%uctionachie'e% an% metho% o fxation..

Eegin earl6 mo&iliation out o &e%M.with

an appropriate %egree o weight on theaecte% extremit6 with a walkerM

ta&le #s> LE as per tolerance ater the6are fxe% with pins..

1nsta&le #s>kept NLE ater surger6H alsoin osteopenic pts..

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eg length %iscrepanc6

8ore than O inch D reGuires shoe lit

Progressing D in%icate% loss o

correction o #.

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Latch out the (ait

Stan)e Phase:

eel trike> /a0ack knifngQ(. 8ax lurch ma6 &e present %ue to (

8ax weakness /pro&a&l6 it ma6 ha'e &een incise% inpost approach0..

/&0 ack o ull knee extension ma6 &e present %ue to

weakness K pain in +ast lateralis /as it is incise% in latapproach0MMM.

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Foot Flat> Contracture o rectus emoris causes hip

exion contracture or re%uces kneeexion

+ast lateralis /incise%0 is weakene% Kpainul %ue to surger6> lea%s to re%uce%oot at phase..

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8i%,stance

Dou&le stance %iminishes %ue to # sitepain..

*liopsoas ma6 &e weak> takes shortsteps %ue to re%uces propulsion o thismuscleM

( me%ius /i incise%0 ma6 &e weakene%>4ren%elen&urg gait

Altere% length,tension relationship incase en%oprothesis> 4ren%elen&urg gait

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Push,o

Not aecte%

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S4ing Phase4he iliopsoas is responsi&le or

concentric contraction to power hip

exion an% a%'ance NLE leg

Bua%riceps unctions to exten% the knee

to assist in acceleration.

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Treatment Ear%y to !mme,iate

T4o =ee$s

Fo(r to Si7 =ee$s

Eight to T4e%"e =ee$s

T4e%"e to Si7teen =ee$s;7


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Ear%y to !mme,iate

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Da6


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4reatment > 4wo weeks

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4 t t @i ht t 2


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4reatment> @ight to 2Leeks

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i% i %


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ong term consi%erations an%

pro&lems

A+N o the emoral hea% ma6 reGuire prostheticreplacement i it &ecomes s6mptomatic an%causes pain.

Nonunion ma6 reGuire prosthetic replacement othe emoral hea% an% neck.

eg length %iscrepanc6 [D$ is rare: &ut ma6 &e along term pro&lem reGuiring a shoe lit.

Prominent an% painul screws: pins: an% platesma6 reGuire remo'al.

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Femoral Neck Fractures

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