Anatomical And Radiological And Clinical Studies Of Proximal Femoral Fractures

Objective: Research and analysis on anatomy, radiology, and clinical features ofproximal femur fracture mechanism, amend classification and treatment principle toguide clinical treatment.Methods: Anatomical and radiological and clinical studies of proximal femoralfractures were analyzed.1. Anatomy Research: Select10elderly patients with normal proximal femur cadavers,each five in male and female patients, mean age72.8±7.6(64to86) years. To do thecoronal plane truncated. Observe proximal femoral trabecular direction of travel anddensity distribution.2. Radiology Analysis: select healthy elderly patients with proximal femur20casesrandomly, to do16-slice spiral CT (Computed Tomography) encryption scan, scan slicethickness0.5mm,10males and10females, average age75.9±8.9(61to93years).Zoning: the proximal femur in the coronal plane is divided into three areas, draw astraight line at the base of femoral neck (B zone), draw a straight line up and downparallel to the base connection0.5cm (A, C District), each region take three equalportions, CT values were measured as trabecular bone density of the region. Put theresulting data into SPSS16.0for statistical analysis, the analysis method using the t test,P <0.05was considered statistically significant.3. Clinical research: clinical manifestations and X-ray (DR, Digital Radiography)diagnose46cases of femoral neck fracture through a retrospective analysis, do spiralCT scanning to clear fracture type, use intramedullary nail fixation. Follow-up after6weeks,3months,6months and12months.Results:1.The anatomical study found: proximal femur coronal plane visiblecortical bone of the medial femoral neck from the base to the bottom of the femoralhead gradually thinning. In addition three main groups of trabecular bone are visible, the main pressure trabecular bone, the secondary pressure trabecular bone and the maintension trabecular bone, The secondary pressure trabecular bone start from lessertrochanter is visible in femoral neck, oblique about45°along the base of the apex ofthe greater trochanter walk the line. The main pressure trabecular bone start from themedial cortical bone from the upper end of the femoral shaft side of the radialdistribution of the femoral neck and ends on the outside of the femoral head1/4. Themain tension trabecular bone ends under1/4of the femoral head upstream along theoutside of the femoral neck with the pressure of trabecular bone and secondary pressuretrabecular bone, a triangle formed by the intersection fragile areas that Ward’s triangle,this area is extremely sparse trabecular bone, The porosity is also significantly largerthan the base of the trabecular bone. In addition, visible the intertrochanteric areaoutside of the secondary pressure trabecular bone trabecular more loose trabecular boneporosity. Therefore, anatomical research base of femoral neck relative to its mechanicalstructure of the inner and outer structure is stronger.2. The Radiology study found: the base of the femoral neck (B zone) CT value is177.25±69.6(88to409), on the bottom of the base0.5cm (zone A) CT value is77.65±70.04(12to241), base men0.5cm(C zone) CT value is77.92±64.27(14to222), statisticalanalysis showed that the base of the femoral neck trabecular bone density (CT value)(Bzone) was significantly higher than small bone on the bottom of the base0.5cm (Azone)beam density (CT value)(t=4.51, p <0.05) was also higher than the basesubordinate0.5cm (C) trabecular bone density (CT value)(t=4.69, p <0.05),thedifference is statistically significant.2.The Clinical study found:46patients with the diagnosis of femoral neck fractures byX-ray (DR), after16-slice spiral CT scan shows that fractures involving the greatertrochanter or lesser trochanter, in line with intertrochanteric fractures feature.2patientsfor economic reasons refused surgical treatment, select conservative treatment. Theremaining44patients take close reduction and internal fixation in accordance withintertrochanteric fracture, all intramedullary nailing,33patients (75%) InterTAN(Smith-Nephew, USA),11patients (25%) PFNA (Synthes, Switzerland). One patientdied after2days of acute myocardial infarction, and the remaining43cases werefollowed up for93.5%of the follow-up rate. All fractures healed well and found noavascular necrosis and other complications.Conclusion: This study confirmed that the base of the femur (B zone) mechanical structure relative to its inner and outer (A, Area C) structure is stronger in anatomystudies, imaging studies confirmed that the base of the femoral neck (B zone) trabecularbone density(CT value) was significantly higher than that of its inner side (A, C region)of trabecular bone density, and the base of femoral neck is too sturdy to have fracture.The clinical study showed evidence of clinical manifestations and X-ray (DR) diagnosisof patients with femoral neck fracture, spiral CT scans are in line with thecharacteristics of intertrochanteric fractures, intramedullary nailing obtain good results.In short, the basicervical fracture may not exist for such X-ray examination found thebasicervical fracture patients, spiral CT scanning should be routinely performed inaccordance with intertrochanteric fractures treated with surgery.