They have a very high complication rate with potentially devastating consequences, including avascular necrosis avn and proximal femoral deformity, especially when diagnosis and treatment are missed or delayed. Hip fractures are classified according to their anatomical location as intracapsular, which involves the femoral head and neck, and extracapsular, which includes intertrochanteric, trochanteric, and subtrochanteric fractures. Doctor answers on symptoms, diagnosis, treatment, and more. Femoral neck fractures pediatric orthopaedic society of. Dislocation together with femoral head transepiphyseal fracture is.
The posterior approach is associated with highest rates of avascular necrosis of the femoral head 17%. Orlin filipov department of geriathic orthopedics, vitosha hospital sofia, bulgaria journal of imab annual proceeding scientific papers 2014, vol. Fracture distraction more than 3mm during stabilization of tibial fractures increases fourfold the odds of developing a nonunion. Hip dislocations and femoral head fractures orthopaedic trauma. Stress fractures may occur in the hip region with metabolic bone disease elevated levels of homocysteine, a toxic natural amino acid. Fractures of the head and neck of the femur in children are very rare, occurring only after a highvelocity trauma, e. The femoral figure 1 anteroposterior radiograph of the pelvis. If this is disrupted, there is a high risk of avascular necrosis. If you continue browsing the site, you agree to the use of cookies on this website. This 20yearold female patient had fracture dislocation of the hip joint. Femoral head fracture an overview sciencedirect topics. The hss orthopedic trauma service has conducted many studies. Radial head fractures are not treated in a plaster cast, as the fracture is stable. Pediatric femoral neck fractures require urgent reduction.
Union bank of india, st martin road, off turner road, bandra w. Removal of this small fracture, in comparison to a full open reduction, seemed to yield better results. A radiai head fracture may be in the elbow joint or just outside the elbow joint. The standard classification of femoral head fractures is that of pipkin. Intracapsular fractures involve the femoral neck between the edge of the femoral head and insertion of the capsule of the hip joint. As the population ages, the number of hip fractures that occur each year rises. Complications and injuries associated with midshaft femur fractures in the adult can be lifethreatening and may include.
Hip fractures are the most common reason for admission to an orthopaedic trauma ward. The head is globular and forms rather more than a hemisphere, is directed upward, medialward, and a little forward, the. Femoral head and neck excision should be reserved for comminuted fractures of the femoral neck, and for longstanding fractures with rounded and fibrotic fracture ends. Insufficiency fractures are the byproduct of insufficient bone structure resulting from disease, poor nutrition or osteoporosis. The radial head is the knobby end of the bone, where it meets your elbow. Definition of nonunion nonunion definition is based on three factors namely, duration of time since injury, characteristics of fracture on serial xrays and lastly clinical parameters assessed by the treating surgeon. Risks of a fractured femur there are risks and complications with this procedure. The anterior approach gives good visualization of the femoral head and fragment to be fixed, but has the highest reported rates of heterotopic ossification up to 42%. Hip dislocations and femoral head fractures sciencedirect. For hemiarthroplasty ha the bipolar heads have a risk. This is a full, transverse fracture of the femoral head that. Advice after breaking your radial head or neck elbow. Fractures of the femoral head rarely occur and are often combined with dislocation of the hip joint.
Detach femoral head from ligamentum teres, repair femoral head fracture with hip dislocated, reduce hip. Some medical conditions such as osteoporosis, cancer, or stress. Bilateral radial head fracture is a very rare injury. Pediatric hip fracture resulting from highenergy trauma is extremely rare in pediatric fractures and is an orthopedic emergency.
Fractures of the femoral shaft often result from high energy forces such as motor vehicle collisions. Osteoporosis other metabolic bone diseases such as pagets disease, osteomalacia, osteopetrosis and osteogenesis imperfecta. Most fractures of the radial head are stable undisplaced or minimally displaced partial fractures without an associated fracture of the elbow or. Femoral head fractures are very rare injuries, almost always caused by hip dislocations. A hip fracture means a fracture of the proximal femur proximal to 5 cm below the lesser trochanter. There are a number of classifications of the femoral neck fractures, as illustrated.
Specifically in relation to femoral head fractures, the classification that is most accepted, and which we used, is the one by pipkin, which divides the fractures into four types. Bali 2011 the reported incidence is 110% of fractures. Patient education geriatric fracture center highland. The femur is the anatomical name given to the long bone of the thigh figure 1. Please see our publications on femoral head fractures, fracture treatment in older populations, and acetabular fractures. Internal fixation is the treatment of choice for femoral neck fracture in young adults. Babst department of trauma surgery, cantonal hospital lucerne, lucerne, switzerland summary this paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale.
Predisposing factors for poor outcome or fracture complications, such as nonunion or femoral head necrosis, are described. The most common are fractures of the pelvis, hip, femur, vertebrae, humerus, hand, forearm, leg, and ankle. A low impact fall is the typical mechanism of injury in the eldery and is often associated with underlying osteoporosis. These fractures are instable, at the same time the oblique fracture line provides more stability with osteosynthesis than pauwels iii fractures. A separate classification of the femoral head fracture was described in 1957 by pipkin.
Femoral head fractures in children are exceedingly rare, accounting for 0. The patient group included one type 1 fracture, eight type 2 fractures, eight type 3 fractures and one type 4 fracture. Rehabilitation guidelines for proximal humerus fracture non operative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf. After reduction, we observed displaced femoral head fracture b, c. Exhaust gas leaks past the valve seat, causing it to expand into an oval shape, this creates hoop stresses in the valve head. The femoral head is fed by three arteries, the main one of which is the medial femoral circumflex. Fractures of the head and neck of the femur in children. The neck of the femur refers to the part of the bone which connects the round headed ball of the hip joint to. Radial head fractures the open orthopaedics journal. Surgeons treated the patients with closed or open reduction and internal. In patients with a suspected occult nof fracture, mri sensitivity 99100% is recommended by many institutions as the secondline test if available within 24 hours, with ct or nuclear medicine bone scan thirdline 17,18.
The fractures of the femoral neck represent approximately 7% of the total of fractures. The femur is the longest, strongest, and heaviest tubular bone in the human body and one of the principal load bearing bones in the lower extremity. The usual mechanism is a fall on an outstretched hand with the elbow partly flexed and forearm in supination. Femoral head fractures are rare injuries that occur most commonly from highenergy impacts, such as those seen in road traffic accidents. Femoral stress fracture, a fracture to the thighbone, is the fourth most common fracture in athletes and military recruits. Pipkin femoral head fracture classification radiology. Both traumatic capital physeal fractures and femoral neck fractures are usually stabilized with two small kirschner wires fig. Infection can occur, requiring antibiotics and further treatment. Hip fractures knowledge for medical students and physicians. Reduce hip through posterior incision, close posterior wound, fix femoral head fracture from anterior approach either now or later. A femoral neck fracture is a condition characterized by a break in the neck of the femur thigh bone. Fractures of the femoral head are also seen with anterior dislocation. They are mainly encountered among elderly women who are affected by both the senile and by the postclimacteric endocrine osteoporosis 3.
This means you can move the joint without causing damage. Hip fractures most commonly occur from a fall or from a direct blow to the side of the hip. The femoral neck can also be completely fractured with the trauma or during reduction attempts. The radius is the smaller of the two bones in your forearm. Fracture of the femoral head is a severe, relatively uncommon injury. Hip fracture following a fall is likely to be a pathological fracture. Pipkin classification is the most commonly used classification for femoral head fractures, which are uncommon but are associated with hip dislocations classification. Martin clinic, lenus orthopaedic care ground floor, farooqui building, near raheja art college, opp. The timing of intervention for femoral head fractures remains controversial, and at least one randomized controlled trial demonstrated significantly worse outcomes for patients who had closed manipulative reduction and delayed open reduction and internal fixation compared with patients who received immediate operative reduction and fixation. She had both acetabular fracture and fracture of the femoral head pipkin type iv. Consider ap pelvis in addition to aplateral views to compare contralateral side. The latter passes through the head of the femur and the. Alignment the anatomic axis of the shaft of the femur is different from the weightbearing, or mechanical, axis fig. In those instances, the only clue may be an enlarged.
Patient education radial head fracture the core institute. Transepiphyseal fracture of the femoral head accounts for only 8% of pediatric hip fractures. Pediatric transepiphyseal seperation and dislocation of. In an intermediate adduction position in this position, the shear forces pass through the. The femoral neck is the most common location for a hip fracture. A 27yearold man with bilateral fatiguetype subchondral stress fracture of the femoral head. A fracture of the hip in an aging adult is not simply a broken bone. This can be partially attributed to wider variety of fracture morphology and in patients prone for development of nonunion. This analysis shows the clinical course of traumatic femoral head and neck fractures in paediatric patients. Femoral shaft fractures reportedly occur at a rate of approximately 20100,000 children in the usa, representing 1. The usual symptoms following this type of fracture include. Bleeding could occur and may require a return to the operating room. Femoral head fractures are rare traumatic injuries that are usually associated with hip dislocations.
Femoral shaft fractures, typically caused by blunt trauma, are the most common major pediatric injuries treated by the orthopedic surgeon. Plain radiographs sensitivity 9398% is the firstline investigation for suspected nof fractures. The oneyear mortality after neck fracture in this group is 24%. Femoral neck fractures and peritrochanteric fractures are equally prevalent and make up over 90 percent of proximal femur fractures.
Femoral head fractures may present in various patterns with or without associated fractures around the hip. Pdf general principles for treatment of femoral head. Falls are the leading cause of fatal and nonfatal injuries among people 65 and older in the united states. Most commonly falls on the wrist, forearm or elbow. Others claim that because impacted fractures often displace spontaneously in recumbency or on early weightbearing, andbecause itisimpossible topredict which fractures r fig. Updates on treatment of femoral head fractures article pdf available in the journal of the korean orthopaedic association 503. Excessive valve temperature together with unequal cooling or cyclic engine loading. Boardman 2009 subtrochanteric valgus osteotomy without the need for bone graft converts the force across the fracture from shear to compression and is the preferred treatment for femoral neck nonunions. Seventy percent of femoral fractures involve the shaft. Helping your elbow to recover after a radial head fracture pdf, 46kb. A pipkin 1 fracture of the femur head is a type of fracture where only a small portion of the femoral head has been broken. Radial head fracture, radial head replacement, internal fixation, elbow, elbow biomech. The femoral head femur head or head of the femur is the highest part of the thigh bone femur. Radiographs at 5 months postoperative revealing healed femoral head and acetabular fractures.