FRACTURE NECK OF FEMUR AND

INTERTROCHANTERIC
FRACTURE.
ANATOMY, MECHANISMS AND CLINICAL FEATURES.

Nikhil Panjiyar
Birat Medical College
 RELEVANT ANATOMY

• The hip joint is a ball and socket joint with inherent

stability.

• The capsule and ligaments of the joint provide additional

stability.

• The acetabulum faces an angle of 30o outwards and

anteriorly. The normal neck-shaft angle of the femur is
125o in adults, with 15o of anteversion.
Relations of the Hip joint.
 Range of Movements
• The flexion is 110°–120°. It is limited by contact of the thigh with the
abdomen and adduction is limited by contact with the opposite thigh. The
range of other movements is as under:

• Extension = 15°

• Abduction = 50°

• Medial rotation = 25°

• Lateral rotation = 60°

Abductor mechanism of the hip
 FRACTURE NECK OF FEMUR
• Commonest site of fracture in elderly.

• Vast majority of patients are Caucasian women in the seventh and

eighth decades, and the association with osteoporosis is so manifest
that the incidence of femoral neck fractures has been used as a
measure of age-related osteoporosis in population studies.
 Mechanism of Injury

• Causative injury is often slight- usually a fall or stumble.

• Possible mechanisms responsible for fracture are:

a) fall producing a direct blow over the greater trochanter

b) external rotation of extremity due to (for eg) catching toe in the

carpet,tripping on a stair, or stumbling on a carpet.
• Though a rare fracture in young person,it may occur and the usual

causes are : a) high velocity (impact) trauma

b) cyclical loading and repetitive strain ( stress fracture)

 Classifications

• Three important classifications are

a) Anatomical classification

b) Pauwel’s classification

c) Garden’s classification
Anatomical classification
Pauwel’s classification
Garden’s classification for femur neck
fracture
Stage 1: The fracture is incomplete, with head tilted in postero-lateral
direction, i.e. into valgus, therefore is known as valgus (abduction)
impacted fracture.
Stage 2: Complete fracture but undisplaced.
Stage 3: Complete fracture with partial displacement.
Stage 4: Complete fracture with total displacement
• Delbet Classification for Pediatric Fracture Neck Femur
Type
1. Transepiphyseal
2. Transcervical
3. Cervicotrochanteric
4. Intertrochanteric
Incidence 2 > 3 > 4 > 1.
 Clinical features

• Usually the patient is elderly female and less commonly elderly male.

• History of trivial trauma like slip and fall in the bathroom

• Pain and restriction of the movements of hip joint

• Inability weight bear on affected limb (except in impacted fracture)

• Tenderness over the anterior hip joint line ( in the groin)

• External (lateral) rotation of the affected limb,the patella facing

outward

• Shortening of the affected limb

• Active straight leg raising is not possible ( except in impacted fracture)

 Intertrochanteric fracture

• Intertrochanteric fractures are, by definition, extracapsular.

• As with femoral neck fractures, they are common in elderly,

osteoporotic people.

• Most of the patients are women in the 8th decade.

 Mechanism of injury

• The fracture is caused either by a fall directly onto the greater

trochanter or by an indirect twisting injury.

• The crack runs up between the lesser and greater trochanter

• The proximal fragment tends to displace in varus.

Classification
 Clinical features

• History of fall

• Pain and swelling in trochanteric region

• Inability to move the affected lower limb

• Tenderness over greater trochanter

• Limb is externally rotated and shortened.

 References ….

• Apley’s system of orthopedics and fracture..9th edition

• Snells Clinical anatomy by regions .. 9th edition

• Maheshwori Essential orthopedics .. 5th edition

• Vishram singh text book of anatomy .. 2nd edition

• Google for images

THANK YOU 