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

Trochanteric fracture, pertrochanteric, simple

Please select a treatment option:
Treatment Main indication Skill Equipment
MIO - Sliding hip screw Surgeon's preference; closed reduction possible Some specialized surgical experience Simple surgical and imaging resources
Nailing Surgeon's preference; unstable fracture; closed reduction possible Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - Sliding hip screw Inability to achieve closed reduction Highly experienced and skilled surgeon Simple surgical and imaging resources

Trochanteric fracture, pertrochanteric, multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
MIO - Sliding hip screw Adequate reduction and bone contact Some specialized surgical experience Simple surgical and imaging resources
MIO - Sliding hip screw with plate Insufficient fracture stability with sliding hip screw alone Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Nailing Surgeon's preference, fracture instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Trochanteric fracture, intertrochanteric

Please select a treatment option:
Treatment Main indication Skill Equipment
Nailing Any intertrochanteric fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Dynamic condylar screw Any intertrochanteric fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Femoral neck fracture, subcapital, undisplaced or impacted

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
MIO - Cancellous screws All subcapital fractures; patients unable to protect their hip Some specialized surgical experience Simple surgical and imaging resources

Femoral neck fracture, transcervical or basicervical

Please select a treatment option:
Treatment Main indication Skill Equipment
MIO - Cancellous screws Pauwels type I-II fractures, good bone quality Some specialized surgical experience Simple surgical and imaging resources
MIO - Sliding hip screw Pauwels type II-III fractures, osteoporosis, comminution Some specialized surgical experience Simple surgical and imaging resources
ORIF - Cancellous screws Failure of closed reduction; Pauwels type I-II fractures, good bone quality Some specialized surgical experience Simple 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 Surgeon or local preference; older patient or irreducible fracture Some specialized surgical experience Simple surgical and imaging resources

Femoral neck fracture, subcapital, displaced

Please select a treatment option:
Treatment Main indication Skill Equipment
MIO - Cancellous screws Pauwels type I-II fractures, good bone quality Some specialized surgical experience Simple surgical and imaging resources
MIO - Sliding hip screw Pauwels type II-III fractures, osteoporosis, comminution Some specialized surgical experience Simple surgical and imaging resources
ORIF - Cancellous screws Failure of closed reduction; Pauwels type I-II fractures, good bone quality Some specialized surgical experience Simple surgical and imaging resources
ORIF - Sliding hip screw Failure of closed reduction; Pauwels type II-III fractures, osteoporosis, comminution Some specialized surgical experience Simple surgical and imaging resources
Arthroplasty Surgeon or local preference; older patient or irreducible fracture Some specialized surgical experience Simple surgical and imaging resources

Femoral head fracture, split

Please select a treatment option:
Treatment Main indication Skill Equipment
ORIF - Small fragment screws Split 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
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