Clinical Anatomy of Proximal Femur

Dr. Khushwant Singh Rathore Department Of

OrthopedicsAll India Institute Of Medical

Sciences, Jodhpur

What is intra-capsular neck femur fracture?

What is extra-capsular intertrochanteric femur fracture?

What is sub-trochanteric fracture?

Why they behave differently?Intra-capsular FractureNon-unionOsteonecrosis

Extra-capsular fractureMal-unionshortening

Sub-trochanteric fractureNonunionVarus deformity

Lessons from Anatomy

Why neck femur fracture goes into osteonecrosis?

Direct disruption of the intra-capsular arteries

End arterial blood supply

Intra-capsular Tamponade Ischemia & Nonunion

Problems with intertrochanteric fractures(Extra-capsular#)

Vascularity is not an issue – problem of plenty

Cancellous bone – Union is not an issue

Issue is Mal-union & Coxa vara

Displacing forces in intertrochanteric fractures

Problems with sub-trochanteric fracture?

Deforming muscle forces (arrows) acting on a subtrochanteric femur fracture. Antero-posterior view showing varus deformity caused by strong abductors acting on the proximal segment (A). Lateral view showing flexion caused by iliopsoas (B).

Clinical application of relevant anatomy