M.E.Müller: Atlas: Fracture 31-B2

Femur, Proximal,
extra-articular fracture,
neck, transcervical 5,37% of the total
8,90% of the femur
12,71% of the segment

923 fractures
31,6% group
37%M, 63%F

1332 fractures
45,6% group
33%M, 67%F

664 fractures
22,8% group
30%M, 70%F

Basicervical Midcervical adduction Cervical shear

These are transcervical fractures sited at the base of the neck of the femur; therefore they are intracapsullar and extrarticular. Because of their radiographic appereance, some of these fractures may be mistaken as pertrochanteric A1.1 fractures, their intracapsular condition being what defines this subgroup. Ref. Manual of Internal Fixation :
282 - 285. 522 - 527.
Surgeon. RO, EN.

In young patients with good bone quality, these fractures can be internally fixed by cancellous screws, of the long thread type in this case in order to improve the hold into the hard trabecular bone of the neck.

In adults and in osteoporotic conditions the use of the DHS implant is more secure, placed over a slight valgus reduction in order to neutralize the shear forces through the dynamic effect tutored by the sliding screw.

When using lag screws in young patients it is neither necessary nor advisable that their thread reaches the peripheral limits of the femoral head. The trabecular bone of the neck is strong enough to resist the traction force and the always compromised blood supply to the femoral head can be better preserved.

preoperative postoperative + 4 months

preoperative postoperative + 4 months

preoperative preoperative

+ 6 months + 6 months

These are fractures through the femoral neck with retroversion and varus displacement caused by an adduction mechanism of injury. There is usually posterior and inferior neck fragmentation that increases their instability. Ref. Manual of Internal Fixation :
260 - 265. 522 - 527.
Surgeon. JG.

The reduction must be either anatomic or with some valgus hypercorrection. The implant chosen must provide dynamic fixation to allow for the fracture collapse after fragment impaction. Internal fixation may be peformed either with a 130º angled blade-plate, or with the addition of a proximal cancellous screw, if the femoral head is large enough, or with a DHS with its screw threads holding tightly in the hard core of the femoral neck.

When the DHS is used, the femoral neck impaction will result in retropulsion of the sliding screw with its consequent protrusion in the trochanteric region. When using a 130º angled blade-plate, the tip of the blade will penetrate further into the head; the amount of predictable impaction (up to 1,5 cm) must be deducted from the blade length measurement.

preoperative preoperative

postoperative postoperative

+ 1 year + 1 year

preoperative preoperative

+ 1 year + 1 year

These are midcervical fractures with a vertical fracture line, produced by a shear mechanism. Ref. Manual of Internal Fixation :
272 - 275. 522 - 527.
Surgeon. RO, JG.

The fracture shown has been treated by a slight valgus reduction, with some overlapping of the proximal over the distal fragment, and DHS fixation with compression. The implant continues to have its tutoring effect for the dynamic compression under loading. This biomechanical system has proved its effectiveness in some cases.

In this fracture subgroup, consideration should be given to the technique of horizontalization of the fracture line by associating a valgus osteotomy and internal fixation with a 120º angled blade-plate as shown later in a 31-B3.1 case. If the osteotomy is not performed, the valgus reduction is imperative.

preoperative postoperative + 4 months

+ 3 year + 3 year




						Femur, Proximal, extra-articular fracture, neck, transcervical	5,37% of the total 8,90% of the femur 12,71% of the segment






These are transcervical fractures sited at the base of the neck of the femur; therefore they are intracapsullar and extrarticular. Because of their radiographic appereance, some of these fractures may be mistaken as pertrochanteric A1.1 fractures, their intracapsular condition being what defines this subgroup.		Ref. Manual of Internal Fixation : 282 - 285. 522 - 527. Surgeon. RO, EN.

In young patients with good bone quality, these fractures can be internally fixed by cancellous screws, of the long thread type in this case in order to improve the hold into the hard trabecular bone of the neck. In adults and in osteoporotic conditions the use of the DHS implant is more secure, placed over a slight valgus reduction in order to neutralize the shear forces through the dynamic effect tutored by the sliding screw.	When using lag screws in young patients it is neither necessary nor advisable that their thread reaches the peripheral limits of the femoral head. The trabecular bone of the neck is strong enough to resist the traction force and the always compromised blood supply to the femoral head can be better preserved.






These are fractures through the femoral neck with retroversion and varus displacement caused by an adduction mechanism of injury. There is usually posterior and inferior neck fragmentation that increases their instability.		Ref. Manual of Internal Fixation : 260 - 265. 522 - 527. Surgeon. JG.

The reduction must be either anatomic or with some valgus hypercorrection. The implant chosen must provide dynamic fixation to allow for the fracture collapse after fragment impaction. Internal fixation may be peformed either with a 130º angled blade-plate, or with the addition of a proximal cancellous screw, if the femoral head is large enough, or with a DHS with its screw threads holding tightly in the hard core of the femoral neck.	When the DHS is used, the femoral neck impaction will result in retropulsion of the sliding screw with its consequent protrusion in the trochanteric region. When using a 130º angled blade-plate, the tip of the blade will penetrate further into the head; the amount of predictable impaction (up to 1,5 cm) must be deducted from the blade length measurement.






These are midcervical fractures with a vertical fracture line, produced by a shear mechanism.		Ref. Manual of Internal Fixation : 272 - 275. 522 - 527. Surgeon. RO, JG.

The fracture shown has been treated by a slight valgus reduction, with some overlapping of the proximal over the distal fragment, and DHS fixation with compression. The implant continues to have its tutoring effect for the dynamic compression under loading. This biomechanical system has proved its effectiveness in some cases.	In this fracture subgroup, consideration should be given to the technique of horizontalization of the fracture line by associating a valgus osteotomy and internal fixation with a 120º angled blade-plate as shown later in a 31-B3.1 case. If the osteotomy is not performed, the valgus reduction is imperative.