Ravi Mittal1, Sumit Banerjee2. 1. Additional Professor, Dept. of Orthopedics, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India. 2. Senior Resident, Dept. of Orthopedics, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India.
Abstract
UNLABELLED: The purpose of this study was to review the principles involved in the management of proximal femoral fractures as reported in the literature. METHODS: A medical literature search in the MEDLINE (PubMed) and Cochrane database was undertaken to review strategies and principles in proximal femoral fracture treatment. Randomized control trials and meta analysis were given preference while case reports/small series were rejected. RESULTS AND CONCLUSIONS: Early anatomical reduction and surgical fixation remains the best option to reduce the risk of complications like non-union and avascular necrosis in treating fracture neck femurs. Cancellous screws continue to be the preferred treatment for fixation of neck femur fractures in younger population until the benefit of using sliding hip screws is validated by large multicentric studies. In the geriatric age group, early prosthetic replacement brings down the mortality and morbidity associated with neck femur fractures. Sliding hip screw (DHS) is the best available option for stable inter trochanteric fractures. The use of intramedullary nails e.g. PFN is beneficial in treating inter trochanteric fractures with comminution and loss of lateral buttress. Intramedullary implants have been proven to have increased success rates in subtrochanteric fractures and should be preferred over extramedullary plate fixation systems.
UNLABELLED: The purpose of this study was to review the principles involved in the management of proximal femoral fractures as reported in the literature. METHODS: A medical literature search in the MEDLINE (PubMed) and Cochrane database was undertaken to review strategies and principles in proximal femoral fracture treatment. Randomized control trials and meta analysis were given preference while case reports/small series were rejected. RESULTS AND CONCLUSIONS: Early anatomical reduction and surgical fixation remains the best option to reduce the risk of complications like non-union and avascular necrosis in treating fracture neck femurs. Cancellous screws continue to be the preferred treatment for fixation of neck femur fractures in younger population until the benefit of using sliding hip screws is validated by large multicentric studies. In the geriatric age group, early prosthetic replacement brings down the mortality and morbidity associated with neck femur fractures. Sliding hip screw (DHS) is the best available option for stable inter trochanteric fractures. The use of intramedullary nails e.g. PFN is beneficial in treating inter trochanteric fractures with comminution and loss of lateral buttress. Intramedullary implants have been proven to have increased success rates in subtrochanteric fractures and should be preferred over extramedullary plate fixation systems.
Authors: Darren J Costain; Sarah L Whitehouse; Nicole L Pratt; Stephen E Graves; Philip Ryan; Ross W Crawford Journal: Acta Orthop Date: 2011-05-11 Impact factor: 3.717