Proximal femur

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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
Closed reduction; short intramedullary nail (PFNA)	Surgeon's preference; unstable fracture; closed reduction possible
Open reduction; sliding hip screw	Inability to achieve closed reduction

A2 Pertrochanteric: multifragmentary fracture Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Closed reduction; sliding hip screw	Adequate reduction and bone contact
Closed reduction; sliding hip screw with trochanteric stabilization plate (TSP)	Insufficient fracture stability with sliding hip screw alone
Closed reduction; short intramedullary nail (PFNA)	Surgeon's preference, fracture instability

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
Open reduction; dynamic condylar screw (DCS)	Especially 31-A3.2 type fractures; optional for 31-A3.1/A3.3

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
Internal fixation without reduction; cancellous screws	All 31-B1 fractures; patients unable to protect their hip

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
Closed reduction; sliding hip screw	Pauwels type II-III fractures, osteoporosis, comminution
Open reduction; cancellous screws	Failure of closed reduction; Pauwels type I-II fractures, good bone quality
Open reduction; sliding hip screw	Failure of closed reduction; Pauwels type II-III fractures, osteoporosis, comminution
Operative treatment; arthroplasty	Surgeon or local preference; older patient or irreducible fracture

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
Closed reduction; sliding hip screw	Pauwels type II-III fractures, osteoporosis, comminution
Open reduction; cancellous screws	Failure of closed reduction; Pauwels type I-II fractures, good bone quality
Open reduction; sliding hip screw	Failure of closed reduction; Pauwels type II-III fractures, osteoporosis, comminution
Operative treatment; arthroplasty	Surgeon or local preference; older patient or irreducible fracture

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

Special considerations
Principles of management of open fractures
Complications Infection Compartment syndrome

*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

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v2.0 2010-11-14