Executive Editor: Joseph Schatzker, Peter Trafton

Authors: Ernst Raaymakers, Inger Schipper, Rogier Simmermacher, Chris van der Werken

Proximal femur 31-C1 ORIF

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Glossary

1 General considerations top

In general, fractures of the femoral head are associated with dislocation of the hip. enlarge

In general, fractures of the femoral head are associated with dislocation of the hip. In 90% the dislocations are posterior and in 10% anterior.
An unreduced dislocation is an emergency because it threatens the blood supply to the head and it may also be accompanied by pressure on a major nerve. Therefore, a reduction must be done as an emergency.
If a closed reduction succeeds, one has the luxury of time to investigate the patient further with a CT and then evolve an appropriate treatment rationale.
If a closed reduction fails, an emergency open reduction must be undertaken.
Small fragments which do not involve the weight bearing portion of the head may be considered for primary resection, particularly if they block an anatomical reduction of the hip.


If a large fragment blocks an anatomical reduction of the hip, under emergency conditions one may consider cutting the ... enlarge

If a large fragment blocks an anatomical reduction of the hip, under emergency conditions one may consider cutting the ligamentum teres to which the fragment is often still attached, and then securing its fixation trough the articular surface as illustrated.
If the hip reduces, but on a CT the fragment is large or incompletely reduced, then it would be fixed through an anterior approach. Once again, transarticular fixation is often necessary.

2 Open reduction top

Reduce the fragment directly and maintain reduction with pointed forceps.  enlarge

Reduce the fragment directly and maintain reduction with pointed forceps.

3 Fixation top

Prior to definitive fixation with screws, secure the fragment with a K wire. enlarge

Preliminary fixation

Prior to definitive fixation with screws, secure the fragment with a K-wire.


The fragment is fixed with either recessed small cancellous lag screws, or headless compression screws (Herbert screws). enlarge

Definitive fixation of the fragment

The fragment is fixed with either recessed small cancellous lag screws, or headless compression screws (Herbert screws).


Choose the screws long enough so that the thread does not cross the fracture line. A single screw does not provide ... enlarge

Number and size of screws

Choose the screws long enough so that the thread does not cross the fracture line.
A single screw does not provide rotational stability. If the size of the fragment allows, use two screws.

v3.0 2017-02-01