New revision 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.

Visit the module entry page here!

AO Surgery Reference—What's New in the Proximal Femur

Michael Baumgaertner, JK Oh, and Theerachai Apivatthakakul present the revised AO Surgery Reference proximal femur module.

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 pages, including fracture descriptions, approaches, patient preparations, indications, procedures, and illustrations

Pages on the following topics have been added:

• Femolar neck system
• Percutaneous reduction techniques (trochanteric fractures and femoral neck fractures)
• Intraoperative imaging
• Patient assessment
• Assessment of reduction quality (trochanteric fractures and femoral neck fractures)
• Complications and technical failures (trochanteric fractures and femoral neck fractures)

Cases have been added to most fracture descriptions. Further cases can be found with the following pages:

• Sliding hip screw – Simple two-part pertrochanteric fractures
• Sliding hip screw with trochanter stabilization plate – Multifragmentary pertrochanteric fractures with incompetent lateral wall
• Femoral neck system – Transcervical femoral neck fractures (simple or multifragmentary)
• Percutaneous reduction techniques (trochanteric fractures)
• Assessment of reduction quality (trochanteric fractures and femoral neck fractures)
• Intraoperative imaging
• Complications and technical failures (trochanteric fractures and femoral neck fractures)

The following videos have been linked with the corresponding approaches:

• Approach to proximal femur and elbow
• Pelvic and acetabular surgical exposure – Gibson approach with a digastric greater trochanteric osteotomy

The following videos have been linked with the corresponding procedures:

• Femoral fractures – Skeletal traction
• Femur, proximal – Trochanteric fractures – Stabilization using the dynamic hip screw (DHS) and a demonstration exercise using DHS in combination with the universal locking trochanter stabilizing plate (ULTSP)
• Femur, proximal – Fractures – Intramedullary fixation using the TFN-Advanced (TFNA) proximal femoral nailing system
• Femur, neck - Fracture 31B – Stabilization using the femoral neck system (FNS)

The following videos have been linked with the corresponding further reading:

• Intraoperative imaging of the proximal femur

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)

Read all release notes here.