see also: [[Fascia Illiaca block]], [[Traction splint]] # Neck of Femur fracture ![[Pasted image 20241105142904.png]] - intra-capsular - higher risk of complications ; poor vascularity and poor quality bone for internal fixation - risks of *avascular necrosis* - usually needs hemiarthoplasty if displaced fracture to prevent avascular necrosis of femoral head ; total hip replacement also considered if severe OA - classified by Garden classification system (see below) - extracapsular - less risk of avascular necrosis - often intramedullary or extramedullary hip screw **Garden classification for intracapsular fractures:** ![[Pasted image 20241105143653.png]] **Evans classification of inter-trochanteric fractures:** ![[Pasted image 20241105143758.png]] example of *avascular necrosis of femoral head*: sclerotic areas of avascular bone with collapse of femoral head due to osteonecrosis ![[Pasted image 20241105143924.png]] ## Mortality increased in first 9 months then tends to mirror similar age group - 10% at 1 month - 35% at 1 year - 50% at 3 years # Subtrochanteric fracture - usually a/w major forces - proximal fragment usually abducted and extenrally rotated due to msucle forces - needs surgery - non-union comon # Femoral shaft fractures > - can have ==haemorrhage up to 2000 mL== into surrounding tissues > - high risk of [[Fat embolism]] if treatment delayed > 24 hours reduction and immobilisation ([[Traction splint|femoral traction splint]]) reduces *pain* and *haemorrhage* - vascular injury usually limited to profunda femora perforating branches to femoral shaft → tense swollen haematoma confined to thigh, but not usually distal circulatory compromise - penetrating or open (compound) fractures may involve femoral artery # supracondylar femoral fracture - often due to axial load to flexed knee - low energy fractures in older females with osteoporosis - high energy in younger males - may be very comminuted - fracture often extends into knee joint - associated with [[Neurovascular assessment|vascular injury]] in 2-3% → ==consider CT angio if features of arterial injury== - can be popliteal artery - knee ligament injury in 20% (PCL and [[tibial plateau fracture]] ) *mgmt:* - flexion of knee to 45 deg if possible reduces posterior angulation of bicondyular fractures and can relieve arterial compression - femoral nerve block when able