Canis ISSN: 2398-2942

Femur: head and neck fracture fixation

Contributor(s): Prof Mark Rochat

Introduction

Uses

  • Femoral neck fractures are divided into six categories:
    • Capital physeal.
    • Subcapital.
    • Transcervical
    • Basilar.
    • Intertrochanteric
    • Subtrochanteric.
  • All uncommon apart from capital physeal fractures which usually occur in growing animals. Concurrent fractures of the greater trochanter occur occasionally.
  • Usually result from torsional injuries or direct blows to the region.

 

  • Diverging pins preferred for capital physeal injuries.
  • Basilar neck fractures best repaired with single lag screw with or without a supporting parallel k-wire Femur: fracture fixation 01 - cannulated screw femoral neck fracture healed.
  • Trochanteric physeal fractures best repaired with pin and tension band wire.
  • Intertrochanteric or subtrochanteric fractures repaired with plates and screws or, occasionally, with trochanteric hook plate and screws.

Advantages

  • Diverging pins are best for capital physeal fractures because primary forces to be countered are rotational and shear forces. Significant penetration of epiphyseal portion of the fracture is not critical because of regional anatomy and its intrinsic bending stability.
  • When repairing basilar neck fractures, bone screws can be placed in lag fashion to achieve compression of fracture site, lending stability to the construct (bone and implant combination) and decreasing healing times.

Disadvantages

  • Parallel pins can be used for repairing neck fractures but difficult to place more than 2-3 pins in relatively thin femoral neck causing inadequate implant strength and leading to implant bending and construct failure.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Generally excellent for adequately stabilized closed fractures.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Gibson K L, vanEe R T & Pechman R D (1991) Femoral capital physeal fractures in dogs: 34 cases (1979-1989). J Am Vet Med Assoc 198 (5), 886-890 PubMed.
  • DeCamp C E, Probst C W & Thomas M W (1989) Internal fixation of femoral capital physeal injuries in dogs: 40 cases (1979-1987). J Am Vet Med Assoc 194 (12), 1750-1754 PubMed.

Other sources of information

  • Simpson D J & Lewis D D (2003)Fractures of the femur.In:Textbook of Small Animal Surgery.3rd ed. Ed. D Slatter D. W B Saunders, Philadelphia. pp 2059-2071.
  • Johnson A L & Hulse D A (2002)Femoral fractures.In:Small Animal Surgery.2nd ed. Ed. T W Fossum.. Mosby, St Louis, Missouri. pp 996-91003.
  • Piermattei D L & Flo G L (1997)Handbook of Small Animal Orthopedics and Fracture Repair.3rd ed. W B Saunders, Philadelphia, pp 478-493.
  • Gilmore D R (1998)Internal fixation of femoral fractures.In:Current techniques in Small Animal Surgery.4th ed. Ed M J Bojrab pp 1040-1044.


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