General considerations
This category represents a large range in anatomical location, fracture comminution and complexity.
Many fractures are not greatly displaced and can be treated nonoperatively.
More severe fractures can be extremely challenging even for experienced surgeons.
Surgery is urgent for:
- Irreducible dislocation
- Hip joint incongruity with risk of femoral head damage
ORIF is the optimal operative treatment for most fractures. For severe arthrosis or osteoporosis, total joint replacement should be considered.
| Nonoperative treatment | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Minimally displaced fractures, poor quality bone, elderly less fit patients, comminuted joint fragments, patients suitable for planned hip replacement |  |
 |
Indications
- Congruently reduced hip joint
- Stable hip joint through range of motion
- No evidence of progressive displacement
Advantages
- Avoidance of risk of surgery
Disadvantages
- Residual displacement may compromise hip replacement
| ORIF through modified Stoppa approach | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Approach of choice when surgery is required | |
 |
This approach may be also combined with a lateral window.
Indications
- Displaced anterior column fracture
- Incongruent hip joint
Advantages for approach
- Much improved visualization of the column
- Direct instrumentation of the quadrilateral surface
- Easy control of the corona mortis
- Easy access to the pubic symphysis
- Reduced dissection of the inguinal canal
Disadvantages
- Difficulty to fix small peripheral anterior wall fragment associated with the anterior column fracture
| ORIF through ilioinguinal approach | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Surgeon’s preference, associated anterior wall fragments | |
|
Indications
- Displaced high anterior column fracture
- Incongruent hip joint
Disadvantages
- Difficulty with visualization and control of hemorrhage from the corona mortis
- Difficulty with instrumentation of the quadrilateral surface
| *Skill | |
|---|---|
 |
Basic surgical experience, no specialized skills |
 |
Some specialized surgical experience |
|
Highly experienced and skilled surgeon |
| *Equipment | |
|---|---|
|
Basic equipment only |
 |
Simple surgical and imaging resources |
|
Full specialized surgical and imaging resources |