FRAKTUR PROKSIMAL FEMUR

Siti Abila Zebadiah

Fakultas Kedokteran Universitas Trisakti
RSUD Chasbullah Abdulmadjid Kota Bekasi
 DEFINISI
• Fraktur : patah tulang, putusnya kontinuitas
dari tulang, tulang rawan sendi, atau tulang
rawan epifisis.
• 90% pasien >50 tahun.
• Perempuan 2 – 3 kali lebih sering.
 Klasifikasi Berdasarkan Anatomi
• Neck of femur
• Intertrochanter
• Subtrochanter
 Neck of Femur Fracture
Non-union fracture due to:
• Being intracapsular, hip synovial fluid impedes
the healing process.
• Loss of blood supply to femoral head and neck
due to disruption of lateral ascending cervical
branches of the medial femoral circumflex artery.
This also increases the risk for avascular necrosis
of femoral head.
• Absence of cambium layer of periosteum in this
region.
Garden Classification
• Type I: incomplete
fracture
• Type II: complete fracture
without displacement
• Type III: complete
fracture with partial
displacement
• Type IV: complete
fracture with complete
displacement
 Stress Fractures
• Femoral neck stress
fractures are often
related to increased
activity. The pattern of
the stress fracture
relates to the lines of
stress within the
proximal femur and has
significant management
implications.
 Femoral Neck :
Tensile Stress Fracture

Superior lateral of the femoral neck, obtain MRI to asses fracture extent
 Femoral Neck :
Compression Fracture

Inferior of femoral neck

Active individual
May potentionally be treated non-operatively
 Neck of Femur Fracture on Young Adults

• Rare occurrence and signifies a high energy

trauma.
• The principle of treatment is anatomic
reduction and fixation, as early as possible, to
reduce the chances of avascular necrosis and
non-union.
 Surgical Considerations
• AVN, non-union may result from delayed
diagnosis  risk for AVN is freater for femoral
neck fracture
• Young (< 65) and/or active  goal: preserve
femoral head, avoid osteonecrosis, achieve
union
• Old (> 75) and/or immobile  goal: restore
mobility and minimize complications
• Non-operative management associated with
higher complication and increased risk
displacement
• If non-displaced, internal fixation preffered
• If displaced fracture, elderly, arthroplasty
preffere
Treatment Algorithm
 Inter Trochanteric Fracture Femur
• These fractures occur in the area between the
greater and lesser trochanter and may involve
these two structures.
Evans Classification
 Management
• Inter trochanteric fractures are usually
managed by surgical fixation.
• The choice of implants depends upon the
fracture pattern, age of patient and existing
comorbidities.
• Risk of AVN and non-union less than in
femoral neck fractures.
 Subtrochanter Fracture
• These are fractures occurring between the lesser
trochanter and isthmus of the shaft of femur.
• The frequency of these fractures is less than that
of neck femur and inter trochanteric fractures.
• These fractures are notorious for intra operative
difficulty in reduction and post-operative
complications like non-union and malunion.
 Management
• Require operative intervention for favourable
results.
• Apart from choosing the right implant, the
other important factor is the reduction of
fracture.
• The muscular forces acting on the fracture
make it difficult to reduce the fracture
fragments and consequently hold the fracture
fragments in reduction during fixation.