Interpretation

Structures

Finding	Definition	Abnormality	Meaning	Consequence
Three bony rings → large ring (cortical line) and small ring	Pelvic Brim and obturator Rings. Gap or step in the cortex = signs of pelvic fracture	Not Continuous	‣	High risk Blood Loss
‣	Line goes from inferior border of SPR superior pubic rami → femoral neck → Medial cortex of femeral neck in proximal femor	Not Continuous	SPR* or ‣ **	High risk AVN - Avascular Necrosis
‣	line down middle of the femoral head and middle of the femoral shaft	< 130	Displaced ‣	High risk AVN - Avascular Necrosis

*inferior border of Supra Pubic Ramus Gap = SPR fracture; **Medial cortex of femoral neck in proximal femur Gap = femoral neck fracture or Inter-trochanteric fracture

Blue: Intra-capsular zone (femoral head and neck)
- Capsule attaches base of neck, just superior to the greater and lesser trochanter
- BLOOD SUPPLY completely provided by the lateral & medial circumflex A. (see below)
Red: Inter-trochanteric zone
Orange: Sub-trochanteric zone: 5 cm below the IT zone

Blood supply dictate surgical decisions

Classification of Hip Fracture: Intra vs Extra- capsular (risk of AVN)

Intra-capsular zone: risk of AVN - Avascular Necrosis
- They the MAJORITY of their blood supply from periosteum → 2/3 of blood supply
- These blood vessels (ascending cervical arteries) exist in periosteum
- Thus displacement = tearing or disruption of periosteum = femoral neck diffusion issue = AVN
  - More displacement = more AVN
- Treatment: OPIF - Open Reduction Internal Fixation or Hip Replacement (arthroplasty) based on AVN risk
Inter-trochanteric zone and sub-trochanteric zone: has NO concern of AVN
- They get periosteum and endosteum
- Multiple routes of blood supp
- Treatment: ALWAYS OPIF - Open Reduction Internal Fixation as there is no AVN risk