Proximal femur

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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
Nailing	Surgeon's preference; unstable fracture; closed reduction possible
ORIF - Sliding hip screw	Inability to achieve closed reduction

Trochanteric fracture, pertrochanteric, multifragmentary Please select a treatment option:
Treatment	Main indication	Skill	Equipment
MIO - Sliding hip screw	Adequate reduction and bone contact
MIO - Sliding hip screw with plate	Insufficient fracture stability with sliding hip screw alone
Nailing	Surgeon's preference, fracture instability

Trochanteric fracture, intertrochanteric Please select a treatment option:
Treatment	Main indication	Skill	Equipment
Nailing	Any intertrochanteric fracture
ORIF - Dynamic condylar screw	Any intertrochanteric fracture

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
MIO - Cancellous screws	All subcapital fractures; patients unable to protect their hip

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
MIO - Sliding hip screw	Pauwels type II-III fractures, osteoporosis, comminution
ORIF - Cancellous screws	Failure of closed reduction; Pauwels type I-II fractures, good bone quality
ORIF - Sliding hip screw	Failure of closed reduction; Pauwels type II-III fractures, osteoporosis, comminution
Arthroplasty	Surgeon or local preference; older patient or irreducible fracture

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
MIO - Sliding hip screw	Pauwels type II-III fractures, osteoporosis, comminution
ORIF - Cancellous screws	Failure of closed reduction; Pauwels type I-II fractures, good bone quality
ORIF - Sliding hip screw	Failure of closed reduction; Pauwels type II-III fractures, osteoporosis, comminution
Arthroplasty	Surgeon or local preference; older patient or irreducible fracture

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

Special considerations
Infection Principles of management of open fractures 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