Internal Fixation of Femoral Neck Fractures

Foreword. 1. Importance of hip fractures. The intact femoral neck. 1.1. Introduction 1.2. Definition and incidence of hip fractures 1.2.1. Nomenclature, basic terms 1.2.2. Incidence of fractures- national and international data 1.2.3. Incidence of femoral neck fractures at the National Institute of Traumatology between 1940-2000 1.3. Regional and surgical anatomy 1.4 Relationship between osteoporosis, age sex and hip fractures 1.5. Certain biomechanical characteristics of the proximal femur 1.6. Blood supply of the femoral head and neck. 1.6.1.Anatomy of the arterial blood supply of the femoral neck region 1.6.2. Anatomy of the venous blood supply of the femoral neck region 1.6.3. Capillary circulation of the femoral head and neck 2. Pathology of femoral neck fracture 2.1.General aspects of pathology 2.2. Stress fracture and spontaneous fracture 2.3. Pathological fracture of the femoral neck 2.4. Damage of the blood supply 2.5. Intraosseous drainage -venous blood flow through the fracture gap. (Significance of venous drainage from the femoral head, screw designed for promoting venous blood flow) 2.6. Types of femoral neck fractures 2.7. Fracture classification: Pauwels, Garden and AO - classifications 2.8. Non-displaced (Garden Type I-II.) femoral neck fracture 3. Diagnostics 3.1. Clinical examination 3.1.1 History 3.1.2. Inspection 3.1.3. Palpation 3.1.4. Functional examination 3.2. Radiological examination, special imaging techniques 3.2.1. Conventional x-ray investigations 3.2.1.1. Typical x-ray view in two planes 3.2.1.2. Additional conventional x-ray examinations 3.2.2. Special imaging techniques 3.2.2.1. Conventional tomography 3.2.2.2. MRI (magnetic resonance imaging) 3.2.2.3. Scintigraphy 3.2.2.4. SPECT (Single Photon Emission Computer Tomography) 3.2.2.5. Investigation of the blood supply of the femoral head (intraosseous venography) 3.2.2.6. DSA (Dynamic Subtraction Angiography) 3.2.2.7. Sonographic investigation 3.2.2.8. CT (computer tomography) 3.2.2.9. DLR (Digital Luminescent Radiography) 3.2.2.10. LDF (Laser Doppler Flowmetry) 3.2.2.11. RSA (Roentgen Stereophotogrammetric Analysis) 3.3. Investigation of the blood supply of the femoral head (intraosseous venography) 3.3.1. Brief description of the technique 3.3.2. Indication of intraosseous venography 3.4. Diagnostic difficulties (recommendations for prevention and avoidance of mistakes) 4. Historical review 4.1. Brief history of the management of the femoral neck fracture 4.1.1. First attempts 4.1.2. Development of osteosynthesis 4.1.3. Evolution of joint replacement techniques 4.1.4. First steps in the operative treatment of femoral neck fractures in Hungary 4.2. Development of osteosynthesis of the femoral neck fractures at the National Institute of Traumatology 4.2.1.Development of nailing techniques 4.2.2. Summary of the principles of management based on 40 years experience 4.2.3. Development and application of screw fixation techniques for the femoral neck fracture at our Institute until 1990 4.2.4. Introduction of percutaneous fixation of femoral neck fractures with two cannulated screws 5. Biomechanical aspects of fixation with cannulated screw - research and developments 5.1. Introduction. Significance of the three point fixation 5.2. Reinforcement of the 1st point of fixation - improvement of fixation in the femoral head 5.2.1. Problems of fixa