In addition to reporting the presence of a fracture, it is important to assess and comment on a number of other features. The fracture is usually evident as a lucency and cortical breach with variable degrees of angulation, impaction and displacement. Regardless of the imaging performed, the number of displaced fragments should be assessed, to enable appropriate classification of the fracture ( Neer classification or AO classification are most commonly used). Additionally, CT (and especially 3D surface shaded reconstructions) has been shown to improve interobserver agreement on classification of proximal humeral fractures 4. Subtle evidence of fracture (eg, as when fractures are minimally displaced or impacted) can include irregularities in femoral neck trabecular density or bone cortex. CT can be useful if adequate views cannot be obtained, if fractures are unusual or if other fractures (e.g. Disimpaction requires a secondary operation to prevent nonunion and subsequent disability. It is impossible at the time the patient presents to predict which fractures will undergo disimpaction. Patients with intracapsular fractures generally tolerate mobilization before patients with extracapsular fractures. Initial treatment is symptomatic with bed rest and pain management. Plain films are usually sufficient to characterize proximal humeral fractures, and thus to determine management. In all the reported series of impacted femoral neck fractures treated conservatively the incidence of disimpaction is between 8 and 15. Nonoperative treatment is reserved for medically infirm patients that cannot tolerate any surgical intervention. These forces may be compressive, tension, torsion or bending. The capsule envelopes the femoral head and neck Subcapital, transcervical and basicervical fractures are intracapsular hip injuries Intertrochanteric and. Lesser the angulation more stable the fracture with a better a prognosis.Proximal humeral fractures usually result from a fall on an outstretched arm. Indirect forces transmitted through the proximal humerus and shoulder are the cause of most fractures. You will need surgery to repair your bone, and recovery can take a year or longer. Comminuted fractures are caused by severe traumas like car accidents. The term comminuted fracture refers to a bone that is broken in at least two places. Pauwel classification is based on post-reduction angulation of fracture line to the horizontal evaluated on a AP radiograph. Comminuted fractures are a type of broken bone. type IV: complete, unstable and fully displaced A study of 123 patients with impacted, subcapital femoral fractures was undertaken to determine the natural history of this injury.type III: complete, unstable and partially displaced.type II: complete, stable and undisplaced.Pauwel classification is based on post-reduction angulation of fracture line to the horizontal evaluated on a AP radiograph. type I: is incomplete, stable and impacted type I: is incomplete, stable and impacted type II: complete, stable and undisplaced type III: complete, unstable and partially displaced type IV: complete, unstable and fully displaced Post-reduction.Further, the displacement is graded as per the position of the principal (medial) compressive trabeculae. Patient Data Age: 60 years Gender: Female x-ray X-ray Frontal An impacted left subcapital neck of femur fracture is suspected on the frontal X-ray of the pelvis. Garden classification is based on the pre-reduction displacement of the femoral head. Presentation Referred for left hip pain and walking inability following a fall in the street. ClassificationĪlthough many classifications are proposed Garden classification and Pauwel classification are generally followed from a practical point of view as these two systems take into consideration the stability of the fractures. The fracture line extends through the junction of the head and neck of femur. Subcapital fracture is the most common type of intracapsular neck of femur fracture.
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