Fracature neck of Femur Examination

General : Age - old
Sex - female
Others : skeletal traction , bed sore

Local : pelvic must be square
two limbs must be identical

Inspection : Altitude : Anterior dislocation - flex
- abducted
- external rotation
- shortening than other side
Posterior dislocation -flex
- adducted
- internal rotation
Swelling
Bruise
Movements - flex ,extension , abduction , adduction ,external rotation, internal rotation
Palpation : local bony tenderness - mid inguinal point ( #NOF )
- greatrochenter point ( # trochenteric )
head of femur - dorsum ilic ( posteror type )
- groin ( pubic type )
- perinium ( obturator type )

Measurement : (1) Apparent length of Right and Left ( no need square postion )
- xiphisternum to lower border of mellolus

(2) Real length ( must in square postion )
- ASIS to tip of medial malleolus
( 3 ) Bryant triangle ( must draw both legs)
- first line . ----- ASIS ကေန ေအာက္ ကို မ်ဥ္းမတ္ဆြဲ
second line .----- ASIS ကေန greater trochanter အ ထိ ဆြဲ
third line. ------greater trochanter ကေန line အ ထိ ဆြဲ
ERRORS : sencond line error ---greater trochanter diplacementanterior or posterior
third line error --- fracture neck of femur
separation of epiphysis

(4) Nelton'sline ( ေဘး ေစာင္း ဆြဲ ရ တဲ ့ မ်ဥ္း )
- Ischial tuberosity to ASIS မ်ဥ္း ေျဖာင့္ဆြဲ ။ ေပ ႀကိဳး နဲ ့ ဆြဲ လည္း ရ သည္ ။
Normal - greater trochanter is below this line
Fracture neck of femur _ greater trochanter is above this line
(5) Schoemaker 's line
- greater tronchanter to ASIS umbilicus
normal ----at umbilicus or above umbilicus
cross at midline
fracture neck of femur -- under the umbilicus
cross to normal leg side

(6) Chiene's test
ASIS to ASIS
Greater tronchanter to greater trochanter
normal ---- parallel of two line
fracture neck of femur ----converge at effected leg side



Diagnosis : Fracture at proximal part of femur probably due to fracture neck of femur

Classification : Garden's classification

fracture incomplete incomplete complete complete
displacement no no partial fully
trabeculae intact align not align disrupted
blood supply normal normal damage ischaemia


VIVA : greator trochanterအ ေပၚ တက္ တာ gluteus medius and gluteus menimus muscle ေတြ ဆြဲ လို ့ တက္ တာ ပါ ။
lesser trochanter ကို ileo-psoas တြယ္ပါ တယ္ ။
Treatment depend on ----age
displacement
associated desease
Treatment ------------reduction
retaining of reduction
rehibilitation

Complication : nonunion
avascular necrosis of head
bedsore
thromboembolism
bronchopneumonia