|
Year |
2002 |
|---|---|
|
Question Number |
207 |
|
Category |
Musculoskeletal Trauma |
Question
A 19-year-old man sustains an isolated, displaced transcervical femoral neck fracture in a motor vehicle accident. An urgent closed reduction attempt in the operating room results in residual varus angulation and 1 cm of displacement. Appropriate management should now consist of
1- in situ fixation.
2- bipolar hemiarthroplasty.
3- total hip arthroplasty.
4- open reduction internal fixation.
5- in situ fixation and bone grafting.
Figures
Answer (click for answer)
Answer: 4
The answer is open reduction internal fixation. In this case, this young patient has undergone a failed closed reduction of his femoral neck fracture which subsequently warrants an ORIF. The indication for ORIF is any displaced femoral neck fracture in patients with adequate bone density, regardless of age. The two reasons ORIF is beneficial is that it allows for optimization in obtaining reduction and it allows for evacuation of the hematoma. The contra-indications for ORIF are rheumatoid arthritis, moderate OA of the ipsilateral hip joint, poor bone density, and pathologic fracture related to metastatic disease. These patients are better served with an arthroplasty.
Reference: Swiontkoski MF: Master Techniques in Orthopaedic Surgery: Fractures: Femoral Neck Fractures. Lippincott and Williams. Chapter 14;2000.
Swiontkowski MF, Winquist RA, Hansen ST Jr: Fractures of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg Am 1984;66:837-846.
Kellam JF, Fischer TJ, Tornetta P III, Bose MJ, Harris MB (eds):Orthopaedic Knowledge Update: Trauma 2, Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, pp 115-124.