of the Femoral Neck and Intertrochanteric Fracturs股骨颈骨折和股骨粗隆间骨折课件.ppt

Fractures of the Femoral Neck and Intertrochanteric Fractures Knut Str?ms?e, MD PhD, Orthopaedic Department, Aker University Hospital, Oslo, Norway Classification of fractures in the proximal femur The Comprehensive AO/ASIF Classification (Müller et al. 1990) of fractures in the proximal femur The comprehensive classification of neck fractures of the proximal femur Pauwel’s classification of neck fractures (1965) (based on the angle the fracture line with the resultant of forces (R)) Garden’s classification (based on the relationship of the medial trabeculae in the head and pelvis) Reported annual incidence of hip fractures per 100 000 of population (Parker and Pryor 1993) Sweden 165 Canada 103 Finland 91 UK 86 USA 80 Malayasia 70 Israel 59 Korea 34 Number of hip fractures in Norway 1979-1999: Cooper C, Campion G, Melton LJ (1992) Osteoporosis Int;2:285-289 6.25 million is an estimated number of hip fractures world wide by 2050 Increasing world population and increasing life expectancy seems to be the most important reason for this increase Why do we experience an increase the number of fractures? Falling frequency increases with age Porosity of bone increases with age Determinants of fracture risk Choice of Treatment policy Fracture related pattern of femoral neck fractures representing risk for osteofixation failure, non-union and avascular necrosis Grade of dislocation (Garden 1972, Thorngren 1991) Size of head fragment (Benterud et al. Acta Orth Scand 1994) Posterior comminution (Benterud et al.1997) Osteoporosis (Bentley 1972, Riska 1969, Anderson 1969, Thorngren 1995) Fracture related pattern of femoral neck fractures leading to a “treatment policy”.. Impacted fractures are reported to have less incidence of non-unions (Bentley G, JBJS;50 B:551,1968, Raymakers, 1993) Impacted fractures develop less segmental collapse in avascular necrosis of the head ? Preservation