Question
A 65-year-old male presented with femur neck fracture. He was managed with closed reduction + cancellous screw. 6 month later X-ray was done in lateral view. X-ray shows non-union & leg shortening. Now, appropriate management options is/are:
| A. |
Unipolar hemiarthroplasty
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| B. |
Bipolar hemiarthroplasty
|
| C. |
Subtrochanteric osteotomy
|
| D. |
Osteosynthesis
|
| D. |
Total hip arthroplasty
|
Show Answer
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Correct Answer � A:B:E
Explanation
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|
Ans. a. Unipolar hemiarthroplasty; b. Bipolar hemiarthroplasty; e. Total hip arthroplasty
In general, operations for ununited fractures of the femoral neck can be grouped into five general classes:
- Osteosynthesis, in which a fracture is refixed with new internal fixation devices;
- Subtrochanteric osteotomy
- Prosthetic replacement (hemiarthroplasty)
- Total hip arthroplasty
- Arthrodesis.
Some general guidelines are as follows:
- In adults < 60 years old, nonunions in which the femoral head is viable can be treated by angulation osteotomy. This provides a line of weight bearing more directly beneath the femoral head.
- In children and in adults < 21 years old, nonunions in which the femoral head is not viable can be treated with an arthrodesis. In exceptional circumstances’ a young adult may be treated with a prosthesis.
- In adults 2l to 60 years old, nonunions in which the femoral head is not viable can be treated with a prosthesis, a total hip arthroplasty, or an arthrodesis, depending on the circumstances in the given Patient and on the experience and preference of the surgeon. Rarely is an arthrodesis indicated in patients older than 50 years of age or in patients with a sedentary occupation.
- ln patients > 60 years, non-union, regardless of the viability of the femoral head, usually are treated with a hemiarthroplasty or a total hip arthroplasty.
