Internal fixation of femoral neck fractures (eBook)

CONTENTS 6
PREFACE TO THE ENGLISH EDITION 12
PREFACE TO THE GERMAN EDITION 14
FOREWORD TO THE GERMAN EDITION 15
FOREWORD TO THE FIRST HUNGARIAN EDITION 16
Chapter 1 PROXIMAL FEMUR FRACTURES. DEFINITION, EPIDEMIOLOGY, ANATOMY, BIOMECHANICS 19
1.1 Introduction 19
1.2 Definition and frequency of hip fractures 20
1.3 Topographic and surgical anatomy 24
1.4 Correlation between osteoporosis, age and sex for hip fractures 33
1.5 Selected biomechanical characteristics of the proximal femur 36
1.6 The blood supply to the proximal femur 40
Chapter 2 PATHOLOGY OF FEMORAL NECK FRACTURES 46
2.1 General pathology 46
2.2 Stress- and spontaneous fractures of the femoral neck 50
2.3 The pathologic neck fracture 52
2.4 Circulatory disturbances 53
2.5 The intraosseous femoral head drainage 56
2.6 Types of femoral neck fractures 57
2.7 Grouping of fractures: Pauwels-, Garden-and AO- classification 61
2.8 The undisplaced neck fracture ( Garden- I and - II) 66
Chapter 3 DIAGNOSTIC INVESTIGATIONS 69
3.1 History and physical examination 69
3.2 Radiographic investigation. Special imaging procedures 70
3.3 Examination of the circulation in the femoral head ( intraosseous venography) 86
3.4 Diagnostic problems (recommendations how to avoid mistakes and errors) 91
Chapter 4 HISTORICAL RETROSPECTION 100
4.1 History of the treatment of hip fractures 100
4.2 The stages of development of internal fixation for femoral neck fractures at the National Institute of Traumatology ( Budapest) 104
Chapter 5 BIOMECHANICAL ASPECTS OF CANNULATED SCREW FIXATION. EXPERIMENTAL INVESTIGATIONS AND DEVELOPMENTS 119
5.1 The importance of three-point buttressing 119
5.2 Reinforcement of the first point of buttressing – improvement of the purchase in the femoral head 121
5.3 Reinforcement of the second buttressing point: Adam’s arch and calcar femorale 133
5.4 Reinforcement of the third buttressing point – lateral cortex 144
5.5 Importance of the loss of reduction in rotation and possibilities to avoid it 151
5.6 Settling of the fracture leading to shortening of the femoral neck 152
5.7 Recent improvements and concepts for the future 156
Chapter 6 JUSTIFICATION FOR EARLY SURGERY 162
6.1 Timing for internal fixation of hip fractures 162
6.2 The progress of emergency surgery in Hungary 162
6.3 Determination of the optimal moment of surgery – summary of investigations performed in Budapest 169
6.4 Guaranteeing the prerequisites for an immediate surgery 170
6.5 Present treatment methods at the National Institute of Traumatology ( Budapest) 173
6.6 General condition and co-morbidity of the elderly accident victim 173
Chapter 7 REDUCTION OF THE FRACTURE 175
7.1 Introduction 175
7.2 Closed reduction of displaced neck fractures 176
7.3 Open reduction of a displaced neck fracture 179
7.4 Reduction of a Garden-I fracture impacted in hypervalgus 181
7.5 Frequent errors of reduction 185
7.6 Guidelines for the assessment of reduction 185
Chapter 8 INTERNAL FIXATION 193
8.1 Preparation for surgery 193
8.2 Implants and instruments for cannulated screw fixation of neck fractures 197
8.3 Technique of percutaneous screw fixation of neck fractures 203
8.4 Guidelines for the assessment of internal fixation 213
8.5 Internal screw fixation with exposure of the femur 220
8.6 Technique to increase the stability of internal fixation 222
Chapter 9 TREATMENT OF UNDISPLACED AND ATYPICAL FEMORAL NECK FRACTURES 225
9.1 Treatment of undisplaced femoral neck fractures ( Garden- I and - II) 225
9.2 Femoral neck fractures in young adults ( 20– 50 years- old) 229
9.3 Femoral neck fractures in children and adolescents 231
9.4 Treatment of stress fractures of the femoral neck 240
9.5 Treatment of pathologic femoral neck fractures 244
Chapter 10 POSTOPERATIVE TREATMENT, EARLY COMPLICATIONS 256
10.1 Early postoperative treatment and prob-lems encountered during this period 256
10.2 Early complications of the surgical wound 258
10.3 Mobilization, follow-up care 262
10.4 Local mechanical complications after internal fixation with cannulated screws and their treatment 263
Chapter 11 TREATMENT RESULTS 269
11.1 Introduction 269
11.2 Comparison between Smith-Petersen nailing and cannulated screw fixation 269
11.3 Score results of the analysis of reduction and internal fixation 273
11.4 Analysis of the causes for loss of reduction 274
11.5 Cannulated screw fixation 1993–94 in comparison with 1997– 98 281
11.6 Treatment of femoral neck fractures – internal fixation versus joint replacement 284
Chapter 12 APPENDIX 289
12.1 Definition of terms particular to the subject of internal fixation of femoral neck fractures 289
12.2 Members in charge of the research team “ Femoral Neck Fractures” at the National Institute of Traumatology ( Budapest) 295
12.3 Foreign teachers, councilors and supporters 295
REFERENCES 297
SUBJECT INDEX 310
AUTHORS’ INDEX 317