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

Surgical procedures sorted by fracture type

Use this menu to jump directly into a specific classification (optional):
A1 A2 A3 B1 B2 B3 C1
A1

Pertrochanteric: simple fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Closed reduction; sliding hip screw Surgeon's preference; closed reduction possible Some specialized surgical experience Simple surgical and imaging resources
Closed reduction; short intramedullary nail (PFNA) Surgeon's preference; unstable fracture; closed reduction possible Some specialized surgical experience Full specialized surgical and imaging resources
Open reduction; sliding hip screw Inability to achieve closed reduction Highly experienced and skilled surgeon Simple surgical and imaging resources
A2

Pertrochanteric: multifragmentary fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Closed reduction; sliding hip screw Adequate reduction and bone contact Some specialized surgical experience Simple surgical and imaging resources
Closed reduction; sliding hip screw with trochanteric stabilization plate (TSP) Insufficient fracture stability with sliding hip screw alone Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; 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
Closed reduction; 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
Open reduction; dynamic condylar screw (DCS) 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 Patients unfit for surgery; severe soft-tissue problems Basic surgical experience, no specialized skills Basic equipment only
Internal fixation without reduction; cancellous screws All 31-B1 fractures; patients unable to protect their hip Some specialized surgical experience Simple surgical and imaging resources
B2

Transcervical fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Closed reduction; cancellous screws Pauwels type I-II fractures, good bone quality Some specialized surgical experience Simple surgical and imaging resources
Closed reduction; sliding hip screw Pauwels type II-III fractures, osteoporosis, comminution Some specialized surgical experience Simple surgical and imaging resources
Open reduction; cancellous screws Failure of closed reduction; Pauwels type I-II fractures, good bone quality Some specialized surgical experience Simple surgical and imaging resources
Open reduction; 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
Operative treatment; arthroplasty Surgeon or local preference; 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
Closed reduction; cancellous screws Pauwels type I-II fractures, good bone quality Some specialized surgical experience Simple surgical and imaging resources
Closed reduction; sliding hip screw Pauwels type II-III fractures, osteoporosis, comminution Some specialized surgical experience Simple surgical and imaging resources
Open reduction; cancellous screws Failure of closed reduction; Pauwels type I-II fractures, good bone quality Some specialized surgical experience Simple surgical and imaging resources
Open reduction; sliding hip screw Failure of closed reduction; Pauwels type II-III fractures, osteoporosis, comminution Some specialized surgical experience Simple surgical and imaging resources
Operative treatment; arthroplasty Surgeon or local preference; 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
Open reduction; small fragment screws 31-C1 fractures with more proximal "Pipkin II" or larger fragments Highly experienced and skilled surgeon Simple 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

v3.0 2017-02-01