Proximal Femur Fractures: NEET PG Essentials
1. Anatomical Classification
- Intracapsular (Femoral Neck): High risk of Avascular Necrosis (AVN) and non-union due to precarious blood supply (medial circumflex femoral artery).
- Extracapsular (Intertrochanteric/Subtrochanteric): Better blood supply; generally heal well but are prone to significant blood loss and collapse.
2. High-Yield Classification Systems
| Fracture Type | Classification System |
|---|---|
| Femoral Neck | Garden Classification (I–IV based on displacement). |
| Intertrochanteric | Boyd & Griffin or Evans (based on stability). |
3. Examination Pearls
- Clinical Presentation: Shortened, adducted, and externally rotated limb.
- Garden Type I/II (Nondisplaced): Treated with internal fixation (cannulated screws).
- Garden Type III/IV (Displaced):
- Young patients: Urgent open reduction and internal fixation (ORIF).
- Elderly patients: Arthroplasty (Hemiarthroplasty or Total Hip Arthroplasty).
- Intertrochanteric Fractures: Standard treatment is a Dynamic Hip Screw (DHS) or an Intramedullary nail (PFN – Proximal Femoral Nail) for unstable patterns.
- Pauwels Classification: Based on the angle of the fracture line (Type III = >50°, highest shear force, high risk of non-union).