![]() patient is supine on the frx table w/ the leg in slight external rotation it is also useful to apply posteriorly directed to the upper tight the leg is then brought back into slight abduction and neutral abduciton apply longitudinal traction as well as lateral traction and then apply internal rotation and abduction apply a folded sheet around the proximal thigh (as high as possible) Closed Reduction of Hip Fracture in Extension: Closed reduction of fractures of the neck of the femur. A treatment for fractures of the neck of the femur. if this maneuver, does not reduce hip satisfactorily, then proceed w/ open reduction rather than repeated attempts with greater force, which may damage blood supply to femoral head if the injured side, stays in internal rotation, then the reduction is complete if the fractured site has significantly more external rotation than the non injured side, then reduction is probably not satisfactory internal rotation is then released, and the surgeon notes the amount of external rotation of both feet the surgeon holds both heels in his palms with both legs in abduction and internal rotation the leg is slowly brought into slight abduction and full extension, while maintaining traction and internal rotation finally, full flexion and adduction "books open" the frx site which then allows the reduction to procede by having these structures relaxed, reduction is possible ![]() further internal rotation also relaxes the Y ligament idea is that when the hip is flexed to 90 deg (quadriped position) all muscles about the hip are maximally relaxed next, while maintaining traction, apply internal rotation to 45 deg flex the hip to 90 deg, w/ slight adduction, and apply traction in line with the femur Leadbetter Technique: (preferred technique) Predictors of early failure of fixation in the treatment of displaced subcapital hip fractures. ![]() Predicting the Mechanical Outcome of Femoral Neck Fractures Fixed with Cancellous Screws: an in vivo study. similar findings were published by Chua, et al (1998), who noted that varus angulation was the biggest predictor of early fixation failure the take home message is that a non anatomic reduction will often lead to postoperative displacement as noted by Weinrobe, et al (1998), major relative risk of redisplacement of femoral neck fractures correlates with initial inferior fracture offset and varus angulation inferior comminution is also important majority of patients with non union, have posterior comminution posterior comminution leads to the loss of a butressing effect posteriorly, w/ subsequent loss of reduction and non-union evaluation of the lateral x-ray after reduction to evaluate posterior comminution of the femoral neck is critical The AP of the whole pelvis (not shown on the X-rays on this page) should be fully assessed because pelvic fractures can mimic the clinical features of a hip fracture.- always attempt closed reduction before open reduction Standard viewsĪP (Anterior-Posterior) pelvis and Lateral hip. Particular care is needed in assessing the X-ray when physical examination is limited, for example if a patient is acutely confused. Repeat X-rays, CT or MRI may be required if pain persists. In this case the X-ray may not show an obvious fracture. It is important to be aware that the common clinical signs of a shortened and externally rotated leg may be absent if the fracture is not displaced. Many hip fractures are clinically and radiologically obvious. Remember to assess the surrounding pelvic bonesįractures of the proximal femur or 'hip' are a common clinical occurrence in elderly, osteoporotic patients.Particular caution is required in the case of acutely confused patients.Not all hip fractures are visible on the initial X-ray and follow-up imaging may be required if concern remains.
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