True about Rx of fracture neck of femur?
Ans. C. An impacted fracture is Rxed conservatively in all age groups.Rx of fracture neck femur:a. This is rightly termed as "unsolved " because of the high incidence of complications.b. This invariable needs operative treatment.c. An impacted fracture is Rxed conservatively in all age groups (hip spica in children and Thomas splint in adults).Unimpacted or displaced fracture:* <60 yrs: internal fixation.* >60 yrs: head excised and replaced by prosthesis done as a primary procedure.* In Some younger patients, especially those presenting late, open reduction of is done.* Internal fixation can be done using any of the following implant:a. Multiple cancellous screws - most commonly used.b. Dynamic hip screws (DHS)c. Multiple Knowles's pins/More's pins - used in children.d. SP nail - not popular now.e. At some centers in general an inter-trochanteric osteotomy (McMurray's osteotomy is preferred).f. Hemiarthroplasty is used for elderly patients & Austin Moore prosthesis is used most commonly.This cannot be used as a method of Rx in younger patients as prosthesis becomes loose over a period of time (8-10 yrs).g. Meyer's procedure ( reduced by exposing it from behind and it is fixed with multiple screws and supplemented with vascularized muscle pedicle bone graft). It is used in treating the fractures presenting late and those with significant comminution. It is also used for non-union of the femoral neck .
SP nail is very popular especially in management of pediatric cases.
Austin Moore prosthesis is most preferred Rx in younger patients.
An impacted fracture is treated conservatively in all age groups.
Meyer's operation should be avoided in treating the fractures presenting late and those with significant comminution.
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