Seminar on Management of Seminar on Management of Hip FractureHip Fracture

88thth July 2007July 2007

Dr. Kou Sio-Kei

PYNEH

ClassificationClassification

Simple and easily applicableSimple and easily applicableGuide treatmentGuide treatmentProvide prognosisProvide prognosisPredict complicationPredict complicationFacilitate communicationFacilitate communicationEnable systematic documentation and Enable systematic documentation and researchresearch

FactorsFactorsAnatomyAnatomy

Blood supplyBlood supplyMuscle attachmentMuscle attachmentCapsular attachmentCapsular attachment

Pathological anatomyPathological anatomyBone qualityBone qualityMechanism of injuryMechanism of injury

Pathological Pathological physiologyphysiology

Bone healingBone healing

FactorsFactors

BiomechanicsBiomechanicsFracture stabilityFracture stabilityDeforming forcesDeforming forcesImplant strength and configurationImplant strength and configuration

Follow upFollow upSystematic data collectionSystematic data collectionValidation and modification of the Validation and modification of the classification systemclassification system

Proximal Femoral FractureProximal Femoral Fracture

Fracture neck of Fracture neck of femurfemurIntertrochantericIntertrochanteric fracturefractureSubtrochantericSubtrochanteric fracturefracturePaediatricPaediatric proximal proximal femoral fracturefemoral fracture

Fracture Neck of FemurFracture Neck of Femur

Age groupAge groupMechanism of InjuryMechanism of InjuryAssociated injuriesAssociated injuries

Anatomical locationAnatomical locationFracture angleFracture angleFracture displacementFracture displacement

Anatomical locationAnatomical locationIntraIntra--capsularcapsular

SubcapitalSubcapitalTranscervicalTranscervical

ExtraExtra--capsularcapsularBasal Basal

Fracture angle Fracture angle ( ( PauwelsPauwels ))

Amount of shearing Amount of shearing forceforceRisk of non unionRisk of non unionRisk of Risk of avascularavascularnecrosisnecrosis

ValgusValgus osteotomyosteotomy

Fracture displacement ( Garden )Fracture displacement ( Garden )Grade I incomplete or Grade I incomplete or valgusvalgus impactedimpactedGrade II complete Grade II complete undisplacedundisplacedGrade III complete partially displacedGrade III complete partially displacedGrade IV complete displacedGrade IV complete displaced

EliassonEliasson modificationmodificationUndisplacedUndisplaced ( I & II )( I & II )Displaced ( III & IV )Displaced ( III & IV )

Other ConsiderationsOther ConsiderationsRisk of AVNRisk of AVNSurgical complicationsSurgical complicationsAge Age Associated injuriesAssociated injuriesGeneral medical conditionGeneral medical conditionPreservation or replacement of the femoral head Preservation or replacement of the femoral head

IntertrochantericIntertrochanteric FractureFracture

Stable and anatomical reductionStable and anatomical reductionSecondary loss of the reduction after internal Secondary loss of the reduction after internal fixationfixation

Boyd and GriffinBoyd and GriffinEvansEvansKyleKyle’’ssAnatomicalAnatomical

SubtrochantericSubtrochanteric FractureFracture

Risk of Risk of malunionmalunion, , malrotationmalrotation, delayed union and , delayed union and non unionnon union

Cortical bone healingCortical bone healingMechanical stressMechanical stress

Fielding and Fielding and MagliatoMagliatoSeinsheimerSeinsheimer

PaediatricPaediatric Proximal Femoral Proximal Femoral FractureFracture

Presence of growth Presence of growth centerscentersVascular anatomyVascular anatomyVery high risk of Very high risk of avascularavascular necrosisnecrosis

The AO classificationThe AO classification

ClassificationClassification

Simple and easily applicableSimple and easily applicableGuide treatmentGuide treatmentProvide prognosisProvide prognosisPredict complicationPredict complicationFacilitate communicationFacilitate communicationEnable systematic documentation and Enable systematic documentation and researchresearch

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