of the Femoral Neck and Intertrochanteric Fracturs股骨颈骨折和股骨粗隆间骨折ppt课件.pptVIP

Fractures of the Femoral Neck and Intertrochanteric Fractures;Classification of fractures in the proximal femur;The Comprehensive AO/ASIF Classification (Müller et al. 1990) of fractures in the proximal femur;The comprehensive classification of neck fractures of the proximal femur;Pauwel’s classification of neck fractures (1965) (based on the angle the fracture line with the resultant of forces (R));Garden’s classification (based on the relationship of the medial trabeculae in the head and pelvis);Reported annual incidence of hip fractures per 100 000 of population (Parker and Pryor 1993); population 4 000 000 1979: 6 800 1989: 9 900 1999: 11800 (290 per 100 000) ;We have to define our problem ;;;Determinants of fracture risk; Choice of Treatment policy;Grade of dislocation (Garden 1972, Thorngren 1991) Size of head fragment (Benterud et al. Acta Orth Scand 1994) Posterior comminution (Benterud et al.1997) Osteoporosis (Bentley 1972, Riska 1969, Anderson 1969, Thorngren 1995) ;Impacted fractures are reported to have less incidence of non-unions (Bentley G, JBJS;50 B:551,1968, Raymakers, 1993) Impacted fractures develop less segmental collapse in avascular necrosis of the head ? ;Preservation of the femoral heador hemi (total) arthroplasty?;Julius Nicolaysen (1831-1909), from Bergen, worked as a Professor in Oslo. He nailed a medial femoral neck fracture in 1893, 2 years before Wilhelm Konrad R?ntgen discovered the X-ray;Osteoporosis is frequent not the main problem Fracture pattern is often different as to the older patient Prosthetic replacement as a primary treatment alternative has to be chosen with greater care than in the older patient ;Transcervical and subcapital femoral neck fracture (31 B and 31-C3) in the “young geriatric” patient;Secondary failures like secondary osteofixation failure as well as segmental collapse may be handled by secondary arthroplasty