2. Absence of cambium layer of periosteum
Intracapsular
Vascular anatomy
Inaccurate reduction
Loss of fixation
3. This layer produces peripheral callus
The portion of the neck which is within capsules
has essentially no cambium layer
Therefore healing in the femoral neck area is
completely dependent on endosteal union alone.
The lack of callus also reduces the rate of union.
4. Unless the fracture fragments are impacted the
synovial fluid can lyse blood clot formation and
thereby destroy another mode of the fracture
healing by preventing the formation of cells and
scaffoldings that would allow vascular invasion of
the femoral head.
5. An Extracapsular arterial ring located at the base
of the femoral neck
Artery of the ligamentum teres
Epiphyseal blood supply
Metaphyseal blood supply
6. Base of the femoral Neck.
Formed by Medial Femoral circumflex artery and
Lateral circumflex femoral artery.
Superior and inferior gluteal arteries also
contribute
The ascending cervical branches are given by
extracapsular arterial ring
7. Derived From The Obturator and Medial
circumflex Femoral Artery
inadequate to supply femoral head with displaced
fractures
8. Can be divided into four groups as anterior,
posterior, medial, lateral.
Of these lateral group provides most of the blood
supply to neck and head.
These arteries form subsynovial intra- articular
arterial ring.
Once branches of these arteries penetrate the
femoral head they are termed as epiphyseal
arteries
9.
10. Prompt reduction and stable fracture
fixation in the treatment of fracture neck of
femur with the hope that the metaphyseal
vessels will promptly reestablish and restore
the circulation may help to reduce the
chances of nonunion and AVN.
11. Type Description Presentation
I Inadequate fixation Relatively early
or nonanatomic
reduction
II Loss of fixation with Later,
Fracture displacement into varus
III Fibrous nonunion Usually late
with no displacement Activity related
& intact Fixation pain
12. Femoral neck fracture should unite by six month
If there is no evidence of healing or patient
continued to have pain nonunion should be
suspected.
Bone scan has to be done to rule out AVN
Followed by that CT scan
14. To improve the mechanical environment at the
fracture site
To improve the biologic environment of the
nonunion site by bone grafting
(nonvascularized,free vascularized, or muscle
pedicle–type grafts)
15. Removal of fixation
Osteotomy through fracture site
Realignment of femoral head on neck
Reinsertion of more stable fixation
Muscle pedicle graft may be used
16.
17. Deformity is usually varus
Postero-inferior displacement of femoral head on
neck.
Initial fixation must be removed
Valgus osteotomy using osteotomy plate with
compression device
18. McMurray’s osteotomy-Just proximal to lesser
trochanter.
Schantz osteotomy-Made through just distal to
lesser trochanter.
The goal of the procedure is to change a shear
force on the neck fracture into a compression force.
Preoperative planning is very important
19.
20. To drill out or open the endosteal canal to allow
revascularisation and endosteal healing of
previous fibrous nonunion.
A vascularised graft should be added to stimulate
the bone union.
Fracture can be stabilized with blade plate or
sliding hip screw.
