Fracture Neck of Femur Imaging and Management - Essay Example

Running head: Fracture Neck of Femur Imaging and Management Fracture Neck of Femur Imaging and Management Name Course Course instructor Date Fracture of femur occurs when the top part of hip bone have broken. Shaft of femur fractures are mostly caused by accidents such as road traffic accidents, the fracture can be from a simple crack to a complete break with many fragments. Normally the fracture will be between one to five inches from the hip joint. Femur being the largest and strongest bone in the human body, it has the capability to withstand the body weight and resisting the entire trauma without getting damaged. Despite its strength when it got injured, the situation may become life threatening. Femur bone can only be injured by certain forces or being weakened by age or diseases. The fractures are commonly seen between two age groups. The first age group would include those less than 25 years of age. Most common accidents at this age are due to road accidents. Individuals in this age group mostly take part in high impact sports such as running or tennis are at risk of stress fractures and femoral neck fractures. The second age bracket is to those individual older than 65 years old. Chronic disease and age weakens their bones hence this age group is at high risk of femur fractures. The whole bone is weakened by the disease and fracture can occur at hip and femoral neck also at the shaft of femur. Active individual are the mostly affected. The fracture occurs when stress is put on the bone or when the individual falls. Fractures can also occur in bed ridden patients when they are being taken to bath or for sheet changing (Goldacre 2002). Suspicion of neck of femur fractures will be made by the radiographer once the patient presents with features such as having a history of a fall, one leg having been shortened and at the same time externally rotated and this patient’s will oftenly be the elderly. Tenderness will also be present at the groin and hip regions. The overall structure of the head as well as the neck of the femur is intended for uniform weight distribution in an efficient and together with minimum biomass with the appropriate transmission of the bony trabeculae in the neck. The tension trabeculae and compression trabeculae which are found along the strong calcar femorale at the medial cortex of the neck of femur are what add up to make an efficient system that will now be able to contain the weight and tension under the exertion of normal stress during locomotion as well as when bearing weight. This is what makes the elderly be more prone to fracture neck of femur since osteoporosis is notorious in this regions and this attributes to the larger percentage of the elderly patients who sustain fracture neck femur. Radiographs are the mostly preferred modality as an initial imaging option available for femoral neck fractures due to it being easily accessible, and has a vast number of co-relational documentation accompanied with surgical results after being used for many years when compared to the other imaging modalities. Evidence of the occurrence of the fracture will be shown by an oblique radiolucent line. In the cases of the fracture neck femur, anterior posterior radiographs will be taken. This will be done when the patient’s legs are internally rotated for this will go a long way in allowing the comparison of the hips and the Singh index of osteoporosis being estimated from the uninjured side. In order to obtain a cross-table lateral of the affected hip, the uninjured hip is flexed while the knee is to be placed at 90 degrees (or this leg will be allowed to rest on the x ray machine). The aiming beam will thus be directed into the groin and this will be parallel to floor and perpendicular to the femoral neck but not the shaft. This view will thus offer an orthogonal assessment of the femoral neck while limiting the injuries resulting from manipulation of the affected hip which is required for a ‘frog-leg’ lateral view. At the same time, it will also prevent pain which being felt during orthogonal assessment. A lateral radiograph is said to be good when it demonstrates the entire femoral head and neck to allow for the correct assessment of angulation as well as displacement in the anterior and posterior directions to be made. When a femoral neck fracture is suspected after not clearly being identified on the anterior posterior radiograph of the pelvis, a dedicated ‘cone down ’anterior posterior view of the hip with internal rotation of 15 degrees as well as gentle traction will have to be obtained. This will go a long way in removing the parallax and the exposure compromises as well as facilitation of the identification of subtle cortical and trabecular interruptions that would occur in a pelvic radiograph (Misra 2002). Basing on the observations of the x ray, there are basically two types of neck of femur which are the intra capsular and extra capsular fractures. Intra capsular fractures also called high fracture neck femur will be further divided along the level of fracture to form the sub capital, Trans cervical and basal respectively. Union is very difficult in this types of fractures due to the proximal fragment normally losing blood supply. The classification of the intra capsular fractures will be based on the gardens classification. Under gardens classification, the radiographer has to rely on the anterior posterior radiograph only. Gardens classification will be grouped into four stages. The 1st stage will be the incomplete fracture of the neck of femur, the second stage is the complete with displacement whereas the third and the fourth stages will be complete with partial displacement and complete femoral neck fracture with total displacement respectively. The sub capital fractures on the other hand will be classified basing on the Pauwels and Linton classifications (Dutton 2006). In pauwels classification, sub capital fractures will be grouped into three types. Fractures will be classified basing on the angle the fracture lines make with the horizontal, pauwel’s angle. The 1st type having an obliquity ranging from 0 to 30 degrees while the second and the third type having obliquity ranging from 30 to 50 and 70 or greater than seventy respectively. Basing on this classification, the greater the obliquity the higher the chances of delayed union or non union. However in Linton’s classification of the sub capital fractures, the sub capital fractures will be grouped into four stages. 1st stage will include the incomplete fractures while the second stage will have the complete but undisplaced fracture. The third and fourth stage will be complete with partial displacement and displaced and totally displaced fractures respectively (Russel et al 2004). The Radiographer will also use the Shenton’s line in trying to rule out the possibility of neck of femur fracture. Shenton’s line is formed on the medial aspect of the medial aspect of the upper part of the femur and the superior pubic ramus. On observation, Shenton’s line should have a smooth curve. However when sharp angulations are noted or any other abnormality in the Shenton’s line, the patient is likely to be having fracture neck femur when an anterior posterior pelvic or a hip radiograph is taken (Goldacre 2002). In the management of fracture femur, conservative management is not the best priority since the fractures occurring at this level will have poor capacity for union being attained. This would be due to the fracture disrupting the supply of blood to the proximal fragment and the lack of organization of fracture hematoma resulting from the presence of synovial fluid. Surgical options will thus be preferred in the management of fracture neck femur. The surgical management will be divided into two main principles. The first surgical principle would be though reduction which would involve the manipulation of the patient in a special orthopedic bed. Rigid internal fixation would be the second surgical management principle and this would involve the stabilizing of the fracture by internal fixation for instance by use of the smith Petersen trifin nail or compression screws. However in the elderly patients who are above 60years, the most preferred methods of management would entail the removal of the head of the femur and replacing it with metal prosthesis like Austin Moore’s prosthesis. In these patients, the prosthesis will enable early ambulation as well as facilitating early weight bearing (Misra 2002). Bibliography Goldacre et al. Mortality after admission to hospital with fractured neck of femur: database study. oxford university press, 2002. Dutton. Orthopaedic examination, evaluation and intervention. McGraw-Hill Medical, 2006. Goldacre. Mortality after admission to hospital with fractured neck of femur . oxford university press, 2002. Misra, Datta &. radiology for surgeons. San Francisco: Greenwich Medical Media, 2002. Read More