This module shows step-by-step descriptions of

• Diagnosis
• Patient preparation
• Approaches
• Reduction & fixation
• Aftercare

 
for all acetabular fractures of the Letournel classification system.
In addition, there are videos, animations, journal articles and book chapters from AO publications
 
Authored by Keith Mayo, Pol Rommens, Carlos Sancineto, Michel Oransky, Executive editor: Peter Trafton

OTA paper 2004: Improvement by Using a Standard Protocol in Cases of Femoral Shaft Fractures

From Journal RCSE

Acetabular Fractures: Diagnosis, Treatment, Indications, Outcome Highly Reputable

AO Classification of Hip Fractures Highly Reputable

Commentary & Perspective on "Hip Arthroplasty for Salvage of Failed Treatment of Intertrochanteric Hip Fractures" by George J. Haidukewych, MD, and Daniel J. Berry, MD by John J. Callaghan, MD*, Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA In summary, this article is helpful to the surgeon performing hip arthroplasty in patients with previous intertrochanteric femoral fractures and to the patients and families of the patients considering this operation. For the patient disabled by the failure of internal fixation of an intertrochanteric femoral fracture, hip arthroplasty can provide durable fixation and pain relief (although the surgeon should explain to the patients that they may have some residual pain in the greater trochanter). Addressing the patients’ preoperative and postoperative medical problems are paramount, as long operative times and large amounts of blood loss are not uncommon with this procedure. Trochanteric osteotomy may be required to provide adequate exposure, and hardware should probably be removed after dislocating the hip to prevent fractures of the femoral shaft. The surgeon should compensate for proximal bone loss with a calcar-replacement implant and bypass any screw-holes in the femoral shaft with use of a long-stem prosthesis. If acetabular cartilage is preserved, a bipolar replacement may aid hip stability. If a total hip arthroplasty is chosen, and hip stability is problematic, a constrained implant can be used (because of low patient demands), especially if the abductor musculature is compromised. Postoperative prophylaxis against thromboembolism should be utilized. If these principles, outlined by Haidukewych and Berry, are followed, satisfying results of salvage hip arthroplasty in patients who have had failed treatment of an intertrochanteric fracture can be obtained.

Reports from Medscape Orthopaedics and Sports Medicine 1999

AONA posting of the AO Classification of Long Bone Fractures Highly Reputable

Abstract Aims: To examine the roles of fracture stability, anatomical reduction and screw position on cut through failure of Dynamic Hip Screw (DHS) implants. Methods: This is a retrospective study of consecutive patients treated with a DHS implant following intertrochanteric fractures of the proximal femur. Fracture stability was assessed from fracture configuration in the initial presentation films. Adequacy of reduction and screw position within the head and neck were recorded using standardized measurements on AP and lateral radiographs taken intra-operatively and post-operatively. Outcome of surgical fracture fixation was assessed at a minimum of 12 months post-operatively. Results: 135 patients were treated during the study period but 40 had died by 12 months and radiographic records were incomplete in 8 patients.87 patients were included in the final analysis. 32 fractures were incompletely reduced. In 6 cases (6.9%) out of 32,fracture fixation was seen to have failed by way of the screw cutting out of the femoral head.Analysis of screw position in this group showed a 5.4% failure of screws placed centrally and 8.0% failure of screws placed off centre. Conclusions: Incomplete reduction is a strong predictor of implant failure by cut out (p=0.0018). Full Text Citation: Arshad Bhatti, Sohail Quraishi, Simon Tan, D.M. Power: Dynamic Hip Screw Failure: Should We Blame The Surgeon Or The Patient?. The Internet Journal of Orthopedic Surgery. 2004. Volume 2 Number 1.

Abstract from Archives Internal Medicine April 2005

Update in eMJA of 1996 study "How best to fix broken hips" (qv)

Wheeless' Textbook of Orthopaedics Abstract of Brumback RJ. Kenzora JE. Levitt LE. Burgess AR. Poka A. Hip. [JC:g7v] :181-206, 1987

Femoral neck fractures in the young adult are a different type of fracture than those seen in the elderly. These younger patients have normal bone density. A simple fall is not going to break the femoral neck. These fractures require high energy type injury mechanisms, and greater than 50% of the patients will have associated injuries as a reflection of the severity of their injury. The mechanisms is usually an axial load to the lower extremity with an abducted hip. The fracture pattern in these patients tends to be more vertical than in the elderly patient. Expert

- Lesser Trochanteric Fracture: - isolated fracture of the lesser trochanter is quite rare but may develop as a result of the avulsion force if the iliopsoas muscle; - it occurs commonly as a component of intertrochanteric fracture; - frx of the lesser trochanter along with a subtroch or intertroch fracture is by definition unstable; - Greater Trochanteric Fracture: - isolated fracture of the greater trochanter may be caused by direct injury or may occur indirectly as a result of the activity of gluteus medius and gluteus minimus muscles;

Extensive Menu on this subject - topics -
Work Up: anesthesia, medical considerations, and timing of surgery - X-rays for Femoral Neck Frx - Operative Techniques: Cannulated Screws: Sliding Hip Screws for Femoral Neck Frx Hemiarthroplasty Open Reduction of Femoral Neck Fracture: Anesthesia and Timing for Femoral Neck Fractures: Antibiotic Prophylaxis Anterolateral Approach Avascular Necrosis following Femoral Neck Fracture: Basilar Neck Frx Blood Supply Calcar Femorale: Capsule Closed Reduction Dislocations and Frx of the Hip Femoral Shaft Fracture Garden's Alignment Index/Eval. of Reduction Garden Classification: types I & II & types III & IV Intertrochanteric Fractures Nail Placement and Depth Non-Union Osteoporosis, Postmenopausal Pathologic Hip Fractures: Pediatric Hip Fractures Radiology of the Hip: Reduction of Femoral Neck Fracture: Singh index Stress Fractures of Femoral Neck: Subtrochanteric frx Thromboembolic Phenomena in Hip Frx and Surgery: Total Hip Arthroplasty Watson Jones Approach to the Hip Joint X-rays for Femoral Neck Fractures: