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Tuesday, 29 April 2014
from 07:00 (CET) until 10:00 (CET)
We are currently preparing the go-live of another release. For the go-live, a portal downtime is planned for Tuesday, 29 April, 2014, from 07:00—10:00 CET. During that time the portal will not be accessible.
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Executive Editor: Joseph Schatzker, Peter Trafton

Authors: Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken, Michael Baumgaertner

Proximal femur

back to skeleton

Glossary

Basic treatment techniques

Proximal femur fracture management with minimal resources
Reduction and casting techniques with limited facilities
A1

Pertrochanteric: simple fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Short intramedullary nail (PFNA) Surgeon's preference; unstable fracture; closed reduction possible Some specialized surgical experience Full specialized surgical and imaging resources
CRIF: Sliding hip screw Surgeon's preference; closed reduction possible Some specialized surgical experience Full specialized surgical and imaging resources
ORIF: Sliding hip screw Failure of closed reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources
A2

Pertrochanteric: multifragmentary fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Sliding hip screw Adequate reduction and bone contact Some specialized surgical experience Full specialized surgical and imaging resources
Sliding hip screw with TSP Insufficient fracture stability with sliding hip screw alone Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Short intramedullary nail (PFNA) Surgeon's preference, fracture instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources
A3

Intertrochanteric fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Long intramedullary nail Any 31-A3.1/A3.3 type fracture; optional for 31-A3.2 Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Dynamic condylar screw Especially 31-A3.2 type fractures; optional for 31-A3.1/A3.3 Highly experienced and skilled surgeon Full specialized surgical and imaging resources
B1

Subcapital fracture with slight displacement

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative treatment Soft-tissue problems; non-ambulatory patients; limited resources Basic surgical experience, no specialized skills Basic equipment only
Cancellous screws All 31-B1 fractures; patients unable to protect their hip Basic surgical experience, no specialized skills Full specialized surgical and imaging resources
B2

Transcervical fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
CRIF: Cancellous screws Pauwels type I-II fractures, high bone quality Basic surgical experience, no specialized skills Full specialized surgical and imaging resources
CRIF: Sliding hip screw Pauwels type II-III fractures, osteoporosis, comminution Basic surgical experience, no specialized skills Full specialized surgical and imaging resources
ORIF: Cancellous screws Failure of closed reduction; Pauwels type I-II fractures, high bone quality Basic surgical experience, no specialized skills Full specialized surgical and imaging resources
ORIF: Sliding hip screw Failure of closed reduction; Pauwels type II-III fractures, osteoporosis, comminution Basic surgical experience, no specialized skills Full specialized surgical and imaging resources
Arthroplasty Older patient or irreducible fracture Some specialized surgical experience Simple surgical and imaging resources
B3

Displaced, subcapital fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
CRIF: Cancellous screws Pauwels type I-II fractures, high bone quality Basic surgical experience, no specialized skills Full specialized surgical and imaging resources
CRIF: Sliding hip screw Pauwels type II-III fractures, osteoporosis, comminution Basic surgical experience, no specialized skills Full specialized surgical and imaging resources
ORIF: Cancellous screws Failure of closed reduction; Pauwels type I-II fractures, high bone quality Basic surgical experience, no specialized skills Full specialized surgical and imaging resources
ORIF: Sliding hip screw Failure of closed reduction; Pauwels type II-III fractures, osteoporosis, comminution Basic surgical experience, no specialized skills Full specialized surgical and imaging resources
Arthroplasty Older patient or irreducible fracture Some specialized surgical experience Simple surgical and imaging resources
C1

Split fracture of femoral head

Please select a treatment option:
Treatment Main indication Skill Equipment
Small fragment screws 31-C1 fractures with more proximal "Pipkin II" or larger fragments Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations

Principles of management of open fractures
Complications
Infection
Compartment syndrome
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2010-11-14