One cannot be sure, prior to examination, whether or not impaction exists, and it is much better to refrain from manipulation altogether, rather than to break up an impaction. The surgeon who is unaccustomed to dealing with these cases had better submit the patient to an X-ray examination before any extensive manipulation is attempted.
Treatment of fracture of the neck of the femur depends on the age and condition of the patient, and whether or not the fracture is impacted. Recumbency is a prime requisite but ambulatory treatment may be necessary for elderly patients due to prolonged confinement issues. There are four recognized methods: recumbency with traction and counter-traction, plaster cast application, ambulatory splint use, and open surgical options.
<Callout type="important" title="Critical Consideration">Each case should be carefully considered and the method or combinations of methods best suited to the patient's condition should be adopted.</Callout>
If the patient is strong enough to remain in bed during repair, Buck’s extension with a long side splint may be used. The bed must be firm; if unavailable, boards can be placed under the mattress to prevent sagging.
<Callout type="gear" title="Essential Equipment">Buck's extension requires a wooden spreader below the foot and adhesive plaster strips for traction control.</Callout>
Counter-extension is obtained by raising the foot of the bed according to weight used. In unimpacted cases, particular care should be taken to correct eversion.
The Ruth-Maxwell method adds lateral traction on the upper end of the femur in addition to longitudinal extension and counter-extension. This method maintains a more nearly normal neck angle during repair and facilitates sitting position without fragment disturbance.
<Callout type="tip" title="Effective Technique">Plaster cast application can vary based on patient age, with middle-aged patients using straight casts extending from waist to toes.</Callout>
In elderly or feeble persons, the cast is applied with knee and hip flexed at right angles for sitting position during day. Special reinforcements should be used at groin and behind knee where cast breaks frequently.
The Thomas splint has been used successfully but requires proper fitting by an experienced blacksmith and leather-worker.
Key Takeaways
- Treatment of femoral neck fractures depends on patient age, condition, and whether the fracture is impacted.
- Recumbency with traction and counter-traction or plaster casts are common non-surgical methods.
- Ambulatory treatment options exist for elderly patients who cannot remain confined to bed.
Practical Tips
- Use Buck's extension method for strong patients able to stay in bed during repair.
- Apply special reinforcements at the groin and behind knee when using a plaster cast.
- Consider lateral traction methods like Ruth-Maxwell for better neck angle maintenance.
Warnings & Risks
- Avoid manipulation if impaction is suspected as it can break up the impaction.
- Ensure proper fitting of Thomas splint by an experienced professional to avoid complications.
Modern Application
While many historical techniques are still relevant today, modern medical advancements such as improved imaging and surgical methods have enhanced fracture treatment outcomes. Understanding these traditional methods provides a solid foundation for emergency care when advanced facilities may not be available.
Frequently Asked Questions
Q: What is the importance of X-ray examination before manipulation?
An X-ray examination helps determine if impaction exists, which can guide whether extensive manipulation should be attempted to avoid breaking up an existing impaction.
Q: Why is recumbency a prime requisite for femoral neck fracture treatment?
Recumbency ensures that the fractured area remains stable and reduces movement that could exacerbate the injury, promoting proper healing conditions.
Q: What are the advantages of using lateral traction in Ruth-Maxwell method?
The Ruth-Maxwell method maintains a more nearly normal neck angle during repair and allows patients to sit without disturbing the fragments, making it easier for them to manage daily activities.