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    Fracture Femur

    Uploaded by

    Wahida Putri
    This document discusses femoral head fractures, including their classification, treatment options, and importance of accurate diagnosis through imaging techniques. It presents the Pipkin classification system for femoral head fractures, which categorizes them based on their location relative to the fovea capitis femoris. Type 1 fractures are below the fovea, while Type 2 are above it. Type 3 also involve an associated femoral neck fracture. The document emphasizes the importance of surgical treatment for most fractures to achieve anatomic reduction and avoid long-term complications like avascular necrosis. It also presents a case study of a patient who suffered a femoral head fracture during a vehicle accident.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Fracture Femur

    Uploaded by

    Wahida Putri
    63 views19 pages
    This document discusses femoral head fractures, including their classification, treatment options, and importance of accurate diagnosis through imaging techniques. It presents the Pipkin classification system for femoral head fractures, which categorizes them based on their location relative to the fovea capitis femoris. Type 1 fractures are below the fovea, while Type 2 are above it. Type 3 also involve an associated femoral neck fracture. The document emphasizes the importance of surgical treatment for most fractures to achieve anatomic reduction and avoid long-term complications like avascular necrosis. It also presents a case study of a patient who suffered a femoral head fracture during a vehicle accident.

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    © © All Rights Reserved

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    This document discusses femoral head fractures, including their classification, treatment options, and importance of accurate diagnosis through imaging techniques. It presents the Pipkin classification system for femoral head fractures, which categorizes them based on their location relative to the fovea capitis femoris. Type 1 fractures are below the fovea, while Type 2 are above it. Type 3 also involve an associated femoral neck fracture. The document emphasizes the importance of surgical treatment for most fractures to achieve anatomic reduction and avoid long-term complications like avascular necrosis. It also presents a case study of a patient who suffered a femoral head fracture during a vehicle accident.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    63 views19 pages

    Fracture Femur

    Uploaded by

    Wahida Putri
    This document discusses femoral head fractures, including their classification, treatment options, and importance of accurate diagnosis through imaging techniques. It presents the Pipkin classification system for femoral head fractures, which categorizes them based on their location relative to the fovea capitis femoris. Type 1 fractures are below the fovea, while Type 2 are above it. Type 3 also involve an associated femoral neck fracture. The document emphasizes the importance of surgical treatment for most fractures to achieve anatomic reduction and avoid long-term complications like avascular necrosis. It also presents a case study of a patient who suffered a femoral head fracture during a vehicle accident.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 19

    /01

    Fracture
    Femur

    Presented by dr. Elvina Prisila, Sp. Rad


    /02
    Introduction 03

    Standard Radiographic Techniques 05

    Classification 06

    Treatment 11

    Case Presentation 12

    Presentation Outline Discussion 13

    Conclusion 14

    References 15

    Fracture Femur dr. Elvina Prisila, Sp. Rad


    Introduction

    • Hip joint is based on articulation of the femoral head and the acetabulum of pelvis,
    and it is a synovial ball-and-socket type joint.
    • More than 70% of all hip dislocation are due to motor vehicle accidents. Femoral
    head fracture are seen approximately in 15 – 15% of posterior hip dislocations and
    are thought to occur due to either (a) mechanical shearing of the femoral head on
    the wall of the acetabulum or (b) avulsion of the ligamentum.

    Fracture Femur dr. Elvina Prisila, Sp. Rad

    /03
    Introduction

    • Delays in appropriate surgical treatment are associated with increased


    complication and mortality rates.
    • Suboptimal treatment of hip fractures may result in debilitating complications
    such as avascular necrosis (AVN), fracture nonunion or malunion, or fixation
    hardware failure.
    • Diagnosing and correctly treating these injuries to avoid long-term sequelae of
    avascular necrosis and osteoarthritis is imperative.

    Fracture Femur dr. Elvina Prisila, Sp. Rad

    /04
    Standard Radiographic Techniques

    • The fracture pattern is an important consideration when deciding upon treatment for femoral head fractures.
    • There are multiple imaging techniques for lateral hip radiography including the
    frog-leg lateral view, Lowenstein view, and cross-table lateral view.

    Fracture Femur dr. Elvina Prisila, Sp. Rad

    /05
    Classification

    • Multiple classification systems for proximal femoral fracture-dislocations have been


    described in the literature, but the morphologic system classifies femoral proposed
    by Pipkin that relatively simple from a radiographic standpoint.
    • In 1957, Garret Pipkin, an orthopedic surgeon from Kansas City, developed this
    calssification system based on lohis obeservation of 24 patients with 25 fractures.

    Fracture Femur dr. Elvina Prisila, Sp. Rad

    /06
    Classification

    Type 1 is defined as a hip dislocation with a femoral head


    fracture caudal to the fovea central or capitis femoris, no
    acetabular fracture, no femoral neck fracture, and small other
    fracture fragments are seen within the hip joint.
    sumber : RadioGraphics

    Fracture Femur dr. Elvina Prisila, Sp. Rad

    /07
    Classification

    Type 2 of Pipkin Classification fractures that extend superior to


    the fovea centralis and defined as a hip dislocation with femoral
    head fracture cephalad to the fovea capitis femoris and
    sumber : RadioGraphics

    ligamentum teres often remains attached to the fracture


    fragment.

    Fracture Femur dr. Elvina Prisila, Sp. Rad

    /08
    Classification

    Type 3 fractures are a type 1 or 2 femoral head fracture with an


    associated femoral neck fracture.
    This type is characterized by high risk of vascular necrosis of
    sumber : RadioGraphics

    the femoral head.

    Fracture Femur dr. Elvina Prisila, Sp. Rad

    /09
    Classification

    Type 4 fractures combine a type 1 or 2 femoral head fracture


    with an acetabular posterior wall fractures and management
    depends on their size and location. This type is believed to have
    poorer prognosis because there are several surgical approaches
    sumber : RadioGraphics

    for the treatment of Pipkin type 4

    Fracture Femur dr. Elvina Prisila, Sp. Rad

    /10
    Treatment

    Nonoperative treatment Operative treatment

    Nonsurgical treatment of a femoral head Most fractures of the femoral head are
    fracture is acceptablen when anatomic treated surgically, given the tendency for
    reduction is achieved and the hip joint is these fracture to have displacement and joint
    stable or if the fracture is inferior to the incongruity.
    fovea and not problematic.

    Fracture Femur dr. Elvina Prisila, Sp. Rad /11


    Case Presentation

    A 19-year-old man, reported to the orthopedic department that he


    had complains of pain and difficult movements of two months
    duration with his right lower limb. He had got tibial operation after
    vehicle injury. Vital sign of patient is normal. No fever. The
    orthopedist sent him to radiology department to get examination of x
    ray pelvis.

    Fracture Femur dr. Elvina Prisila, Sp. Rad /12


    Case Presentation

    Fracture Femur dr. Elvina Prisila, Sp. Rad /13


    Case Presentation

    Fracture Femur dr. Elvina Prisila, Sp. Rad /14


    /15

    Discussion

    The femoral head necrosis occurs due to lack of bloody supply resulred from prolonged dislocation of
    the hip joint and accelerates if the femoral head ligament is cut in operation to deteriorate the blood
    supply.
    Surgical treatment for injuries involving the hip joint are generally complex duet to it is deep
    location, massive soft tissues in situ, and vulnerable femoral head vascularity.
    Anatomically and biomechanically fragments of the femoral head are pushec anteriorly during hip
    injury in sitting position duet o the backward forces of the femur.

    Fracture Femur dr. Elvina Prisila, Sp. Rad


    /16

    Conclusion

    • Femoral head fractures caudal to the fovea centralis are Pipkin 2 lesions and involve the weight-
    bearing portion of the femoral head.
    • This CT scan is not only important for assessing the femoral head fracture pattern (size, location,
    comminution), but also to evaluate the congruity of the hip joint and determine the presence or
    absence of intra-articular loose fragments.

    Fracture Femur dr. Elvina Prisila, Sp. Rad


    /17
    References

    • Gammons, M. 2018. Hip Dislocation. Medscape [Internet].


    • Ross, James R., Michael J. Gardner. 2012. Femoral Head Fractures. Curr Rev Musculoskelet Med. 5(3): 199–205.
    • Simunovic, Nicole, PJ Devereaux, Mohit Bhandari. 2011. Surgery for Hip Fractures: Does Surgical Delay Affect
    Outcomes. Indian J Orthop. 45(1):27–32.
    • Peng, Shih-Hui, et al. 2020. Surgical Treatment of Femoral Head Fractures. Biomed Journal. 43(5): 451–7.
    • Zhao, Bei MD, et al. 2017. Pipkin Type Iii Femoral Head Fracture-Dislocation Combined with Complicated Acetabular
    Fracture: A Rare Case Report And Literature Review. Medicine. 96(50): 2021.
    • Luijkx, Tim, Jeremy Jones, et al. Proximal Femoral Fractures. Radiopaedia Articles [Internet].
    • Yu, Xiao, Qing-Jiang Pang, Xian-Jun Chen. 2017. Clinical Results of Femoral Head Fracture-Dislocation Treated
    According to the Pipkin Classification. Pakistan J Med Sci. 33(3): 650–653.
    • Lim, Seung-Jae, Yoo-Soo Park. 2015. Plain Radiography of the Hip: A Review of Radiographic Techniques and Image
    Features. Hip Pelvis. 27(3): 125-133

    Fracture Femur dr. Elvina Prisila, Sp. Rad


    /18
    References
    • Sam, Richard, Yu Chen Y, Nahid Tayebi, Ellen Sidransky. 2020. Generating Pluripotent Stem-Cell Derived Organoids to
    Model Gaucher Disease Type 2. Molecular Genetics and Metabolism.132(2): S94.
    • Charkhand, Behshad, et al. 2019. Effect Of Ambroxol Chaperone Therapy on Glucosylsphingosine (Lyso-Gb1) Levels in
    Two Canadian Patients With Type 3 Gaucher Disease. Molecular Genetics and Metabolism Reports. 20: 1–2.
    • Oguri, Masayoshi, et al. 2020. High-Frequency Component in Flash Visual Evoked Potentials in Type 3 Gaucher Disease.
    Brain & Development. 42(1): 19–27.
    • Genetics Home Reference. 2020. Gaucher Disease. Medline Plus [Internet]. [Download thn bulan tgl]; volume (terbitan):
    Available on : -link web-.
    • Sidransky, Ellen. 2018. Gaucher Disease Workup. Medscape [Internet]. [Download thn bulan tgl]; volume (terbitan):
    Available on : -link web-.
    • Vancauwenberghe, Thomas, et al. 2015. Imaging of The Spleen: What The Clinician Needs To Know. Singapore Med J.
    56(3) :133–44.
    • Sanofi Genzyme. 2017. Taking Charge of Your Care : Seven Tests That Are Important For People Living With Gaucher
    Disease Type 1. Amerika Serikat (US): Genzyme Coorporation.

    Fracture Femur dr. Elvina Prisila, Sp. Rad


    /19

    Thank You
    Fracture Femur dr. Elvina Prisila, Sp. Rad

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