M.E.Müller: Atlas: Fracture 31-B1

Femur, Proximal, extra-articular fracture, neck, subcapital,
with slight displacement 2,51% of the total
4,15% of the femur
5,94% of the segment

658 fractures
48,2% group
23%M, 77%F

421 fractures
30,9% group
28%M, 72%F

285 fractures
20,9% group
22%M, 78%F

Impacted in valgus >= 15º + Q Impacted in valgus < 15º + Q Non impacted

These are subcapital femoral neck fractures, displaced in valgus and impacted. They differ from the 31-B1.2 and 31-B1.3 fractures by the degree of displacement and impaction, with the 31-B1.3 being the more severe ones because they are not displaced in valgus, so they are less stable under loading. Ref. Manual of Internal Fixation :
282 - 285. 522 - 527.
Surgeon. MV, LO.

Joint aspiration of the haemoarthrosis to reduce pressure is the emergency treatment. Its effect on the blood supply to the femoral head is controversial but, in any case, it relieves pain. Moderate valgus displacement should not be reduced except for the posterior rotational component. In the undisplaced fractures, slight valgus reduction should be attempted in order to horizontalize the subcapital fracture line.

Internal fixation is performed with two or three short thread cancellous screws giving interfragmentary compression. The cannulated screws are easier to insert precisely. The use of washers to improve the cortical

support is recommended. If there is interference between the washers, some may be obviated.

The number of screws depends on the size of the head and the hardness of its core. There should be at least one proximal and one distal screw. Three screws better neutralize the combined shear and torsional forces. From the biomechanical standpoint, the most important thing is the fracture line horizontalization and bone participation in the stability of the assembly through the great friction between the fragments obtained by the compression.

preoperative preoperative

+ 4 months + 4 months

preoperative preoperative

+ 6 months + 6 months

preoperative preoperative

+ 4 months + 4 months

+ 1 yeard + 1 yeard

preoperative preoperative

+ 0 months + 0 months

+ 1 year + 1 year

...

..

-

preoperative preoperative

+ 0 months + 0 months

preoperative preoperative

+ 1 yeard + 1 yeard




						Femur, Proximal, extra-articular fracture, neck, subcapital, with slight displacement	2,51% of the total 4,15% of the femur 5,94% of the segment






These are subcapital femoral neck fractures, displaced in valgus and impacted. They differ from the 31-B1.2 and 31-B1.3 fractures by the degree of displacement and impaction, with the 31-B1.3 being the more severe ones because they are not displaced in valgus, so they are less stable under loading.		Ref. Manual of Internal Fixation : 282 - 285. 522 - 527. Surgeon. MV, LO.

Joint aspiration of the haemoarthrosis to reduce pressure is the emergency treatment. Its effect on the blood supply to the femoral head is controversial but, in any case, it relieves pain. Moderate valgus displacement should not be reduced except for the posterior rotational component. In the undisplaced fractures, slight valgus reduction should be attempted in order to horizontalize the subcapital fracture line. Internal fixation is performed with two or three short thread cancellous screws giving interfragmentary compression. The cannulated screws are easier to insert precisely. The use of washers to improve the cortical	support is recommended. If there is interference between the washers, some may be obviated. The number of screws depends on the size of the head and the hardness of its core. There should be at least one proximal and one distal screw. Three screws better neutralize the combined shear and torsional forces. From the biomechanical standpoint, the most important thing is the fracture line horizontalization and bone participation in the stability of the assembly through the great friction between the fragments obtained by the compression.