University of north carolina chapel hill high compressiontension stress area with cantilever bend deformity. Pdf because of the anatomical peculiarities of the subtrochanteric region, treatment of fractures in this region remains challenging. Scribd is the worlds largest social reading and publishing site. Overall the incidence has been estimated to be approximately 1520100,000. Radiographic study on the anatomical characteristics of the. The fracture configuration and location, as well as the femoral anatomy can be determined primarily from biplanar radiographs. The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Most frequently, these fractures are seen in two patient populationsnamely, older osteopenic patients who have sustained a lowenergy fall 8, 10 and younger patients who have been involved in highenergy trauma. The above image is a 3d reconstruction from the raw data of a ct of the abdomen and pelvis, such that the patient did not have to undergo additional scanning and radiation exposure to get this image of the femur. Successful management requires a thorough knowledge of the regional anatomy, a comprehensive. Fractures of the distal end of the femur continue to present a challenge to orthopedic surgeons. Bd chaurasiya human anatomy 7th edition pdf series is coming soon.
This page includes the following topics and synonyms. In patients with good bone quality and integrity of the posterior cortex of the femur. Threepart spiral fractures of the proximal third of the femur, in which the third part is a butterfly fragment type iv. We have uploaded a genuine pdf ebook copy of this book to our online file repository so that you can enjoy a blazingfast and safe downloading experience. Proximal femur fractures are associated with 22% allcause mortality at 30 days and 36% at one year. This is a wellrecognized complication in adult femoral neck fractures treated with cannulated screw fixation. Neck of femur fractures free download as powerpoint presentation. The nail length may also be determinated intraoperatively using the guide wire ruler together with the guide wire. Subtrochanteric femur fractures are an uncommon injury in orthopedics, but when they are encountered they may present difficulties in management. The challenge is the variability of proximal femur anatomy within the population. The femur is a big bone, and the proximal part of the femur has a number of important parts that make it part of the hip joint and the muscles. A practical, evidencebased approach to the diagnosis and management of proximal femur fractures. Ostrum, md cooper hospital university medical center camden, new jersey femur fractures common injury due to major violent trauma 1 femur fracture 10,000 people more common in people 65 yo femur fracture leads to reduced activity for 107 days, the average length of hospital stay is 25 days motor vehicle, motorcycle, auto. Ballspike pushers, schanz screws, or steinmann pins, placed through an anterior punctiform access route, can be used as a joystick to reduce the flexion of the proximal fragment in subtrochanteric fractures of the femur.
Anatomy note neckshaft angle note the height of the greater trochanter relative to the center of the femoral head the reduction should aim to recreate the patients normal anatomy. Atypical subtrochanteric and diaphyseal femoral fractures. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. Specifically, subtrochanteric fractures of the hip are increasingly being diagnosed. The hip is a ballandsocket joint composed of the femoral head and acetabulum. There are many books for anatomy one can read, but bd chaurasia is still considered the best book of anatomy. The femur is the longest, heaviest, and strongest bone in the human body. Although aseptic necrosis of the femoral head is infrequent after intramedullary nailing of femoral shaft fractures in adolescents, it is a significant complication. Part i discusses basic principles, including anatomy, biomechanics and surgical approaches to the proximal femur. Color atlas of anatomy mosc medical college hospital. Schatzker j, waddell jp 1980 subtrochanteric fractures of the femur. Management of subtrochanteric proximal femur fractures. Six months later she developed left thigh and knee pain and radiology.
Download bd chaurasia pdf book for free below in ebook format. Subtrochanteric intertrochanteric fractures, including any subtrochanteric fracture with extension through the. Nonoperative or operative treatment for undisplaced femoral neck fractures. Among the large number of books on anatomy appearing year after year, few. The treatment of femoral subtrochanteric fractures with. The subtrochanteric region of the femur is an area of high compressive stresses medially. Subtrochantericfractures of the femur jbjs august 2009 clamp assisted reduction of high. The subtrochanteric region of the femur is an area of great stress concentration and, due to its muscular insertions, is subjected to several deforming forces. Anatomy and physiology is a dynamic textbook for the yearlong human anatomy and. Subtrochanteric fractures of the femur springerlink.
Learn about human anatomy and physiology online by downloading openstaxs free anatomy and physiology book and using our accompanying study guide. Subtrochanteric fractures seinsheimer classification. Subtrochanteric fractures generally have a good prognosis due to the good supply of blood and adequate collateral circulation to this region of the femur with a low incidence of avascular necrosis and nonunion. Neck of femur fracture subcapital intertrochanteric. Bd chaurasia human anatomy pdf free download all volumes. Bone screws referenced in this material are not intended for screw attachment or fixation to the posterior elements pedicles of the cervical thoracic or lumbar spine. The piriformis fossa lies at the base of the neck and is oriented in line with the femoral shaft. The purpose of this paper is to examine the recent literature on the epidemiology, classification, initial evaluation, and definitely treatment for these injuries. Proximal femur fractures an evidencebased approach to. Intertrochanteric fractures in younger individuals are usually the result of a highenergy injury, such as a motor vehicle accident or fall from a height. Prophylactic bilateral intramedullary femoral nails for. The traction strength of each muscle group after a fracture can lead to the displace. Oblique view of the right pelvis demonstrates a comminuted subtrochanteric fracture inferior to the greater and lesser trochanters.
Comminuted subtrochanteric fracture inferior to the greater and lesser trochanters. Anatomy, bony pelvis and lower limb, femur statpearls ncbi. The dorr classification is the most commonly used classification system for describing the relationship between the proximal femoral anatomy and the emoral diaphysis, otherwise known as the canalflare index. Hip fracture is generally affected by hip anatomy, the applied forces to the hip, and bone mechanical properties.
Neck of femur nof fractures can occur anywhere from the subcapital region of the femoral head to 5cm distal to the lesser trochanter fig. The overall incidence rate of fractures of the proximal femur is found to be approximately 230 per 100,000 patients with approximately 510% of these fracture occurring within the st region 1, 2. An intertrochanteric fracture is a specific type of hip fracture. Subtrochanteric fractures of the femur request pdf. The bones pdf class videos for anatomy and environmental. The subtrochanteric region of the femur consists primarily of cortical bone. Fractures of the femoral shaft and subtrochanteric region. Comminuted fractures with four or more fragments type v.
Open femur 5 determine entry point the entry point is a determinant factor for the entire operation, especially for. Femur fractures occur with a variety of mechanisms and are based on the specific location of fracture. The femoral neck should be scrutinized for fracture in both subtrochanteric and femoral shaft fractures. A more recently identified patient population consists of. Thus, the asbmr leadership appointed a multidisciplinary, international task force to address key questions related to case definition, epidemiology, risk factors, diagnostic imaging, future areas for. Subtrochanteric femur fracture fixation remains one of the most challenging procedures to orthopedic surgeons. In these instances, assessment must be made of possible associated head, neck, chest, and abdominal injuries. These will assist the physician to determine the optimal treatment strategy and avoid. Occur in the carpometacarpal joint of the thumb and between the femur and. Anatomy made of dense trabecular bone capsule inserts on it line anteriorly, but at midcervical level posteriorly muscle attachments determine deformity calcar femorale vertical wall of dense bone that extends from posteromedial aspect of femoral shaft to posterior portion of femoral neck helps determine stable versus unstable fracture patterns. In this section, hip anatomy is explained to show why the hip is. Anatomy when the centers are higher the trochs valgus.
It is inherently stable owing to the depth of the acetabulum and surrounding labrum, allowing femoral rotation in the coronal, sagittal, and transverse planes while limiting femoral head translation. Original article a comparative study of long third. This article will describe how an anatomy coloring book can facilitate learning and retention in an easy, fun and effective way. It articulates superiorly with the hip bone at the hip joint, and. Handbook of fractures 5th edition pdf free download. Apart of the choices of implant used, patient positioning for intramedullary nailing of subtrochanteric femoral fracture plays a crucial role in fracture reduction and should be considered during preoperative planning. The classic deformities are flexion provoked by the iliopsoas, abduction by the gluteus medius, and external rotation by the external rotators of the proximal fragment of the femur. Review of the patients medical records reveal that she had been evaluated 3 months prior for. This can help with surgical planning to select a stem. They are usually associated with highenergy trauma in young adults or with lowerenergy falls in the elderly. Postoperative infection, however, is a potentially serious compilation. Jones introduction subtrochanteric femur fractures are much less common than hip or shaft fractures.
There are three volumes of bd chaurasia of anatomy and these are as below. Free anatomy and physiology textbook for download openstax. The lesser trochanter is itself fractured and separated from the femur. Hip fracture is a medical condition in which there is a break in the continuity of the femoral bone. Intracapsular femoral head or neck and extracapsular intertrochanteric and trochanteric. Discusses femoral anatomy and biomechanics, surgical approaches, femoral head and neck fractures, intertrochanteric and subtrochanteric fractures, nonunions and femoral shaft fractures, as well as quality and patient safety. This book is distributed under the terms of the creative commons attribution 4. The value of the tipapex distance in predicting failure of fixation of peritrochanteric fractures of the hip. This timely resource organizes and presents the most uptodate, evidencebased information on the evaluation and management of all aspects of proximal femur fractures, divided into three succinct sections.