Internal Fixation of Femoral Neck Fractures: An Atlas

Transcription

1 Internal Fixation of Femoral Neck Fractures: An Atlas Manninger, Jeno ISBN-13: Table of Contents Foreword. 1. Importance of hip fractures. The intact femoral neck Introduction 1.2. Definition and incidence of hip fractures Nomenclature, basic terms Incidence of fracturesã â â œ national and international data Incidence of femoral neck fractures at the National Institute of Traumatology between Regional and surgical anatomy 1.4 Relationship between osteoporosis, age sex and hip fractures 1.5. Certain biomechanical characteristics of the proximal femur 1.6. Blood supply of the femoral head and neck Anatomy of the arterial blood supply of the femoral neck region Anatomy of the venous blood supply of the femoral neck region Capillary circulation of the femoral head and neck 2. Pathology of femoral neck fracture 2.1.General aspects of pathology 2.2. Stress fracture and spontaneous fracture 2.3. Pathological fracture of the femoral neck 2.4. Damage of the blood supply 2.5. Intraosseous drainage à â â œvenous blood flow through the fracture gap. (Significance of venous drainage from the femoral head, screw designed for promoting venous blood flow) 2.6. Types of femoral neck fractures 2.7. Fracture classification: Pauwels, Garden and AO à â â œ classifications 2.8. Non-displaced (Garden Type I-II.) femoral neck fracture 3. Diagnostics 3.1. Clinical examination History Inspection Palpation Functional examination 3.2. Radiological examination, special imaging techniques Conventional x-ray investigations

2 Typical x-ray view in two planes Additional conventional x-ray examinations Special imaging techniques Conventional tomography MRI (magnetic resonance imaging) Scintigraphy SPECT (Single Photon Emission Computer Tomography) Investigation of the blood supply of the femoral head (intraosseous venography) DSA (Dynamic Subtraction Angiography) Sonographic investigation CT (computer tomography) DLR (Digital Luminescent Radiography) LDF (Laser Doppler Flowmetry) RSA (Roentgen Stereophotogrammetric Analysis) 3.3. Investigation of the blood supply of the femoral head (intraosseous venography) Brief description of the technique Indication of intraosseous venography 3.4. Diagnostic difficulties (recommendations for prevention and avoidance of mistakes) 4. Historical review 4.1. Brief history of the management of the femoral neck fracture First attempts Development of osteosynthesis Evolution of joint replacement techniques First steps in the operative treatment of femoral neck fractures in Hungary 4.2. Development of osteosynthesis of the femoral neck fractures at the National Institute of Traumatology Development of nailing techniques Summary of the principles of management based on 40 years experience Development and application of screw fixation techniques for the femoral neck fracture at our Institute until Introduction of percutaneous fixation of femoral neck fractures with two cannulated screws 5. Biomechanical aspects of fixation with cannulated screw - research and developments 5.1. Introduction. Significance of the three point fixation 5.2. Reinforcement of the 1 st point of fixation à â â œ improvement of fixation in the femoral head Problems of fixation in the femoral head Modifications in thread characteristics for improvement of fixation Comparison of pull-out tests of screws with different thread quality and thread diameter Tensile strength of cannulated screw with the use of palacos injected into the femoral head through the canule Evaluation of investigations

3 Investigation of rotational stability with the use of a plate placed on the screw Improvement of fixation with the use of three screws Improvement of fixation in the femoral head à â â œ clinical examples nd point of fixation à â â œ reinforcement of the Adam-arc and calcar femorale Problems of stability of the 2 nd point of fixation Improvement of stability with the use of a small plate securing both screws Improvement of stability in Pauwels Type III. fractures with the combination of screws with different thread length Securing angular stability in case of deficient Adam-arc, with the use of dynamic collo-diaphyseal (DCD) plate 5.4. Reinforcement of the 3 rd point of fixation - the lateral cortex Problems with the stability of the 3 rd point of fixation - varus or rotational redisplacement Thickening of the lateral cortex in cases, where the small plate had not been attached to the distal screw Experimental investigation of the small plate Relevant points in the correct use of the small plate Clinical examples for the stabilising effect of the small plate 5.5. Significance of the rotational displacement and its prevention 5.6. Sliding effect à â â œ "useful" sliding of screws. Apposition of fragments with shortening of the femoral neck 5.7. Further plans of development 6. Timing of operation, principle of emergency, anaesthesia 6.1. Principle of emergency in the management of femoral neck fractures 6.2. Use of the principle of emergency in the routine of trauma services in Hungary 6.3. Summary of our investigations on the timing of femoral neck fixation 6.4. Conditions of emergency operation 6.5. Our evidence based management principles 6.6. General condition of the old patients, associated diseases 7. Significance of reduction 7.1. Introduction 7.2. Reduction of displaced femoral neck fracture 7.3. Open reduction of femoral neck fracture 7.4. Reduction of Garden I. fracture impacted in hypervalgus 7.5. Common errors in fracture reduction 7.6. Guidelines for the evaluation of reduction 8. Technique of osteosynthesis 8.1. Preoperative preparation Preparation for urgent (within 6 hours) osteosynthesis Technique of local anaesthesia Preparation of delayed osteosynthesis à â â œ use of skeletal traction

4 Algorythm for the management of femoral neck fractures 8.2. Implants and instruments for cannulated screw fixation Implants for cannulated screw fixation Instruments for cannulated screw fixation 8.3. Technique of percutaneous screw fixation Introduction Detailed technique of percutaneous screw fixation Positioning, prepping, draping Site of skin incision, exposure and point of entry of the drill Eight main steps of the operation Common technical errors and their prevention 8.4. Guidelines for the evaluation of osteosynthesis 8.5. Cannulated screw fixation with exposure 8.6. Techniques for enhancement of stability of osteosynthesis Introduction Use of screws with 9,5mm thread diameter Use of screw and plate Use of three cannulated screws Plate fixed to both screws Use of DCD plates and attachments 9. Management of non-displaced (Garden Type I-II.) and atypical fractures of the femoral neck 9.1. Management of non-displaced (Garden I-II.) femoral neck fractures Introduction Management of non-displaced (Garden I-II) fractures at our Institute Our results with the osteosynthesis of Garden I-II. fractures 9.2. Femoral neck fractures in adults between years 9.3. Femoral neck fractures in children and adolescents 9.4. Management of stress fracture of the femoral neck 9.5. Management of pathological fractures of the femoral neck Pathological fracture caused by a cyst Compression fracture in osteomalatia (adult rickets) Femoral neck fracture in osteopetrosis (Albers-Schànberg disease) Femoral neck fracture in osteosclerosis Femoral neck fracture after poliomyelitis Femoral neck fracture in osteogenesis imperfecta Femoral neck fracture as a result of primary or metastatic tumour 10. Postoperative management. Pathology and treatment of early general and surgical complications

5 10.1. Problems and management in the early postoperative period Immediate postoperative period Early general complications, their prevention and management Cardiovascular complications Neurological complications Other general complications Early complications in the wound Haematoma Clinical presentation and diagnostics of postoperative haematoma Treatment of postoperative haematoma Infection Clinical presentation and diagnostics of superficial and intraarticular infection Treatment of infection Mobilisation, weight bearing, follow-up, aftercare Mechanical complications following cannulated screw fixation and their management Redisplacement Loosening of implants Fracture of the femur after femoral neck fracture fixed with implants 11. Results of treatment Introduction Comparison of cannulated screw fixation and Smith-Petersen nailing Value of the score for evaluation of the quality of reduction and osteosynthesis Analysis of the causes of redisplacement Role of the quality of reduction and osteosynthesis Role of the fracture type in redisplacement Gardenà â â s classification Pauwels classification Quality of fracture surfaces Relationship between age (osteoporosis) and redisplacement Experiences with the use of the small plate Comparison of the results of cannulated screw fixations made between and Management of femoral neck fractures à â â œ osteosynthesis or endoprothesis? Appendix Glossary of the terms used in this book, with reference to femoral neck fracture References List of authors

6 Index