orthopedics notes

Apr 16th, 2015
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FEMORAL FRACTURESFemoral NeckIntertrochantericSub TrochantericFemoral shaftSupracondylarFemoral Neck FracturesVascular Anatomy1Intraosseous cervicalvessels that cross themarrow spaces frombelow.2the artery of theligamentum teres3the retinacularvessels,, which runalong the femoralneck beneath thesynoviumClinical SignificanceProblems associated with healing ofintracapsular fractures elsewhere in thebody. No periosteal layer, all healing mustbe endosteal. Angiogenic-inhibiting factorsin synovial fluid - inhibit fracture repairPressure of the hemarthrosis can exceed thediastolic blood pressure and, hence,embarrass the blood supply to the femoralhead - intracapsular tamponadeEpidemiologyincreased freq withagedementiamalignancychronic illnessin young patients usually are causedby high-energy trauma and often areassociated with multiple injuriesClassificationGarden1.an incomplete or impacted fracture2.a complete but undisplaced fracture3.a complete partially displaced fracture4.a completely displaced fractureAnatomic LocationIntracapsularsubcapital and transcervicalExtracapsularGardenManagementAgeGrade 1Grade 2Grade 3Grade 4<50Pin in situPin in situReduce & PinTHR or Reduce & Pin50-70Pin in situPin in situReduce & PinHemiarthroplasty70-80Pin in situPin in situ or HemiarthroplastyHemiarthroplastyHemiarthroplasty>80Hemiarthroplasty or Pin in situ

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