May 9, 2024

Neglected Fracture Neck of the femur is defined when the fractured neck is untreated for 3 weeks or more. (Because internal fixation alone has a very high failure rate)

Sandhu Classifications for Neglected Neck of femur fracture

Stage 1Stage 2Stage 3
Fracture surface freshFracture surface sclerosed/smoothFracture surface smooth
The gap between fragments: ≤1cmGap between fragments: >1cm <2.5 cmThe gap between fragments: >2.5 cm
Size of proximal fragment ≥ 2.5 cmSize of proximal fragment ≥ 2.5 cmSize of proximal fragment <2.5 cm
No AVN femoral headNo AVN femoral headAVN femoral head
Sandhu et al classification
Sandhu Classifications for Neglected Neck of femur fracture

Treatment Options

Stage 1

Close reduction +/- Internal fixation with cancellous cannulated screw + free fibular graft

ORIF + Screw + Vascularized fibular graft

ORIF + Screw + Bone muscle pedica graft (Quardatus femoris/ Sartorius/ TFL)

Abduction osteotomy + Interna fixation + DHS/ 135 degree blade plate, double angle blade plate

Mcmurray osteotomy

Stage 2

Close reduction +/- Internal fixation with cancellous cannulated screw + free fibular graft

ORIF + Screw + Vascularized fibular graft

ORIF + Screw + Bone muscle pedical graft (Quardatus femoris/ Sartorius/ TFL)

Non-operative treatment:

  • The patient had already started walking,
  • Can squat
  • Cannot afford operative treatment
  • Medically unfit patient

Stage 3

Mcmurray osteotomy

Replacement arthroplasty

Non-operative treatment is considered for

  • The patient had already started walking,
  • Can squat
  • Cannot afford operative treatment
  • Medically unfit patient

The trabecular pattern in the proximal femur

Principle Compressive trabeculae

Secondary Compressive trabeculae

Greater trochanter trabeculae

Principle tensile trabeculae

Secondary tensile trabeculae

The trabecular pattern in the proximal femur

Ward’s Triangle

Area of minimal density

Babcock’s Triangle

Frequent sites of Tuberculosis

See also: Tuberculosis of the Hip Joint

See also:

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