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Proximal femoral fractures: Principles of management and review of literature
Authors:Ravi Mittal  Sumit Banerjee
Affiliation: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;1. Department of Orthopaedics, Skåne University Hospital, Lund, Sweden;2. Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Sweden;1. College of Precision Instrument and Opto-electronics Engineering, Tianjin University, 92, Weijin Street, Nankai District, Tianjin 300072, China;2. Department of Orthopaedics, Tianjin Medical University General Hospital, 154, Anshan Street, Heping District, Tianjin 300052, China;3. Department of Orthopaedics Institute, Tianjin Hospital, 406, Jiefang Nan Street, Hexi District, Tianjin 300211, China;4. Department of Orthopaedics, Tianjin Gongan Hospital, 176, Nanjing Street, Heping District, Tianjin 300042, China;1. Department of Orthopaedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan;2. Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan;3. School of Public Health, National Defense Medical Center, Taipei, Taiwan;1. Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, 640 Jackson Street, Mailstop 11503L, St Paul, MN 55101, USA;2. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA;1. Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK;2. Newcastle University, UK;3. LIMM Section Musculoskeletal Disease, University of Leeds, UK;4. NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, UK;1. Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan;2. Change Gung University, Taoyuan, Taiwan;3. Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan
Abstract:
PurposeThe 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.
Keywords:Proximal femoral fractures   Surgical fixation   Management   Hemiarthroplasty   Intramedullary devices
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