Release notes of Proximal femur

The content has been revised and extended by Theerachai Apivatthakakul (TH) and Jong-Keon Oh (KR), with Michael Baumgaertner (US) as executive editor.

Karl Stoffel (CH) and Daniel Rikli (CH) contributed chapters on the femoral neck system and intraoperative imaging, respectively.

The main differences to the second edition are:

• Reorganization of the fractures according to the AO/OTA Classification 2018
• Description of combined fracture patterns and their management
• Revision of all indications, procedures, and illustrations

Pages on the following topics have been added:

• Femolar neck system
• Intraoperative imaging
• Patient assessment
• Assessment of reduction quality
• Complications and technical failures

Cases have been added to fracture descriptions and procedures.

The proximal femoral material, third edition, includes a detailed description of the following injury types and their management.

Isolated single trochanter fractures:

• Nonoperative treatment
• Tension band wiring
• Hook plate fixation

Simple two-part pertrochanteric fractures:

• Fracture management with minimal resources
• Nonoperative treatment
• Sliding hip screw
• Nailing

Simple pertrochanteric fractures with posteromedial involvement:

• Fracture management with minimal resources
• Nonoperative treatment
• Sliding hip screw
• Nailing
• Sliding hip screw with trochanter stabilization plate

Multifragmentary pertrochanteric fractures with incompetent lateral wall:

• Fracture management with minimal resources
• Nonoperative treatment
• Sliding hip screw with trochanter stabilization plate
• Nailing

Intertrochanteric fractures:

• Fracture management with minimal resources
• Nonoperative treatment
• Nailing (short nail)
• Nailing (long nail)
• Angled blade plate

Impacted or nondisplaced subcapital femoral neck fractures:

• Fracture management with minimal resources
• Nonoperative treatment
• Cannulated screws
• Femoral neck system

Displaced subcapital femoral neck fractures:

• Fracture management with minimal resources
• Nonoperative treatment
• Cannulated screws
• Femoral neck system
• Hemiarthroplasty
• Total hip arthroplasty

Transcervical femoral neck fractures (simple or multifragmentary):

• Fracture management with minimal resources
• Nonoperative treatment
• Sliding hip screw with antirotation screw
• Femoral neck system
• Hemiarthroplasty
• Total hip arthroplasty

Transcervical shear fractures of the femoral neck:

• Fracture management with minimal resources
• Nonoperative treatment
• Sliding hip screw with antirotation screw
• Femoral neck system
• Hemiarthroplasty
• Total hip arthroplasty

Basicervical femoral neck fractures:

• Fracture management with minimal resources
• Nonoperative treatment
• Sliding hip screw with antirotation screw
• Femoral neck system
• Hemiarthroplasty
• Total hip arthroplasty

Split fractures of the femoral head:

• Fracture management with minimal resources
• Nonoperative treatment
• Excision
• ORIF - Mini-fragment or headless screws

Depression fractures of the femoral head:

• Fracture management with minimal resources
• Nonoperative treatment
• Excision
• ORIF - Mini-fragment or headless screws

Femoral neck and greater trochanter fractures:

• Fracture management with minimal resources
• Nonoperative treatment
• Hemiarthroplasty with reconstruction of greater trochanter

Femoral neck and head fractures with hip dislocation:

• Fracture management with minimal resources
• Nonoperative treatment
• Hemiarthroplasty
• Total hip arthroplasty

Femoral head fractures with posterior wall fracture of the acetabulum:

• Fracture management with minimal resources
• Nonoperative treatment
• ORIF

Approaches:

• Posterolateral (posterior) approach to the hip
• Direct lateral approach to the proximal femur
• Trochanteric flip osteotomy through the Gibson interval
• Limited lateral approach for implant insertion in the proximal femur
• Approach for proximal femoral nailing
• Anterolateral approach (Watson-Jones) to the proximal femur
• Anterior approach (Smith-Petersen) to the proximal femur

Patient preparations:

• Supine patient position on a fracture table
• Supine patient position on a radiolucent table
• Supine patient position for arthroplasty
• Lateral decubitus position

Further reading:

• Assessment of patients with a proximal femoral fracture
• Perioperative care for elderly hip fracture patients
• Intraoperative imaging of the proximal femur
• Assessment of reduction quality (trochanteric fractures)
• Assessment of reduction quality (femoral neck fractures)
• Complications and technical failures in trochanteric fracture management
• Complications and technical failures in femoral neck fracture management
• Prognosis of proximal femoral fractures in elderly patients
• References on proximal femoral fracture management

Basic techniques:

• Skin traction
• Skeletal traction
• Percutaneous reduction techniques (trochanteric fractures)
• Percutaneous reduction techniques (femoral neck fractures)

The content was revised by Ernst Raaymakers (NL), Inger B Schipper (NL), Rogier Simmermacher (NL), Christiaan van der Werken (NL), with Joseph Schatzker (CA) as executive editor.

Paul Demmer (ZA) created chapters on fracture management with minimal resources, with Christopher Colton (UK) as executive editor.

Rogier Simmermacher (NL) gave feedback on the content of the second edition. His comments and suggestions were considered and included by the editor Steve Krikler (UK).

The proximal femoral material, second edition, included a detailed description of the following injury types and their management.

Trochanteric fracture, pertrochanteric, simple:

• MIO - Sliding hip screw
• Nailing
• ORIF - Sliding hip screw

Trochanteric fracture, pertrochanteric, multifragmentary:

• MIO - Sliding hip screw
• MIO - Sliding hip screw with plate
• Nailing

Trochanteric fracture, intertrochanteric:

• Nailing
• ORIF - Dynamic condylar screw

Femoral neck fracture, subcapital, undisplaced or impacted:

• Nonoperative treatment
• MIO - Cancellous screws

Femoral neck fracture, transcervical or basicervical:

• MIO - Cancellous screws
• MIO - Sliding hip screw
• ORIF - Cancellous screws
• ORIF - Sliding hip screw
• Arthroplasty

Femoral neck fracture, subcapital, displaced:

• MIO - Cancellous screws
• MIO - Sliding hip screw
• ORIF - Cancellous screws
• ORIF - Sliding hip screw
• Arthroplasty

Femoral head fracture, split:

• ORIF - Small fragment screws

Femoral head fracture, depression

Femoral head fracture, with femoral neck fracture

Approaches:

• Lateral approach
• Nailing approach
• Anterolateral approach
• Posterolateral approach
• Iliofemoral approach
• Direct lateral approach

Patient preparations:

• Lateral decubitus position
• Supine position for nailing
• Supine on conventional table
• Supine position (fracture table)

Further reading:

• Medical assessment and care
• Flynn reduction maneuver
• Proximal femur fracture management with minimal resources - Reduction and casting techniques with limited facilities
• References

The first edition was created by Christiaan van der Werken (NL), Ernst Raaymakers (NL), Inger B Schipper (NL), Rogier Simmermacher (NL), and Michael Baumgaertner (US).