0:00

Similar to the previous case.

0:03

This is a 70-year-old male with left-sided pain,

0:06

status post fall, history of dementia,

0:09

and also prior history of possible left hip fracture.

0:13

So this image is from the scan agram on a ct,

0:17

and we can see that there is change in the offset

0:20

of the femoral head neck junction on the left

0:22

with slight valgus angulation suggesting a hip fracture.

0:28

A CT is performed, which shows this sclerotic band

0:32

along the femoral neck and the valgus angulation.

0:36

The question is whether this is acute or chronic.

0:39

And so in this case, an MRI was done, which demonstrates

0:43

that in addition to the fracture line, there is an area

0:46

of bone mar edema pattern.

0:48

And so this represents an acute

0:50

or at least unhealed hip fracture.

0:53

So let's talk about hip fractures. These are the main types.

0:57

They can occur as subcapital right below the femoral head,

1:01

transc, cervical bai, cervical inter,

1:06

or it can be with fracture dislocations of the hip.

1:10

So in terms of applying these designations,

1:14

if the fracture is just below the femoral head,

1:17

we can consider it subcapital.

1:20

If it's through the mid portion of the neck,

1:22

it's transc cervical.

1:23

If it's at the lower portion of the neck,

1:25

it's considered Bai cervical.

1:28

And if it goes between the two T trochanters,

1:30

it's Inca trocanter.

1:32

So for proximal femur fractures,

1:34

it's females greater than males

1:36

with the intracapsular fractures.

1:39

And as a reminder, the capsule basically goes down

1:43

to the intra enteric region of the hip Joint.

1:46

Femoral neck fractures are common.

1:49

Femoral head fractures are uncommon, and

1:52

because of that tenuous blood supply,

1:55

as we previously discussed, about 15 to 35% will go on

1:58

to osteonecrosis.

2:00

Extracapsular fractures are considered in the

2:02

intertrochanteric and subter regions.

2:06

So there is a garden classification of subcapital fractures,

2:10

which designates them as either incomplete

2:13

with some valgus angulation,

2:16

or complete with virus angulation and displacement,

2:20

or complete and displaced.

2:22

As a reminder, valgus deformities tend

2:26

to bring the body outside of a circle.

2:28

They're more angular, whereas virus deformities bring your

2:32

body more into a circle in the hip.

2:34

We can use an angular measurement

2:37

to help with that designation.

2:39

So if we look at the normal situation, the typical

2:42

femoral neck angle is somewhere between 120 to 140 degrees.

2:47

If it's greater than 140 degrees by measurement,

2:51

or the femur is now pointing away from the center

2:55

of the body, bringing the body out

2:57

of a circular configuration,

2:59

That's considered a valgus angulation

3:01

or a valgus deformity.

3:04

If the angle measures less than 120 degrees,

3:08

or now the femur

3:09

or the distal portion of the fracture is pointing medially

3:13

or bringing the body more into a circular configuration,

3:17

then that's considered a virus angulation

3:20

or a virus fracture, and that's how we apply those labels.

3:25

So here we have a subcapital fracture, similar to some

3:29

of the other examples that we've seen,

3:30

and we can see that there's valgus angulation here.

3:34

While in this case where we have a complete fracture

3:37

with displacement, we've generated virus angulation.

3:42

And here's an example of an intra enteric fracture

3:44

with multiple parts.