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 1 | Stage 2 | Stage 3 |
|---|---|---|
| Fracture surface fresh | Fracture surface sclerosed/smooth | Fracture surface smooth |
| The gap between fragments: ≤1cm | Gap between fragments: >1cm <2.5 cm | The gap between fragments: >2.5 cm |
| Size of proximal fragment ≥ 2.5 cm | Size of proximal fragment ≥ 2.5 cm | Size of proximal fragment <2.5 cm |
| No AVN femoral head | No AVN femoral head | AVN femoral head |
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
Ward’s Triangle
Area of minimal density
Babcock’s Triangle
Frequent sites of Tuberculosis
See also: Tuberculosis of the Hip Joint
See also:
