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Femoral Neck Fractures
Updated: Oct 9 2017

Femoral Neck Fracture Closed Reduction and Percutaneous Pinning

Preoperative Patient Care
Operative Techniques

Preoperative Plan


Template intramedullary nail and cephalomedullary screws

  • measure length of the hip screws


Surgical walkthrough

  • resident can describe key steps of the operation verbally to attending prior to beginning of case.
  • list potential complications and steps to avoid them

Room Preparation


Surgical instrumentation

  • cannulated screws


Room setup and equipment

  • radiolucent fracture table (Jackson fracture)
  • c-arm fluoroscopy


Patient positioning

  • make sure patient has Foley urinary catheter in place
  • patient supine with feet padded with webril and placed firmly in fracture table boots if contralateral leg dropped down, if raising contralateral leg up 90° use thigh holder
  • padded post deep into groin, move genitals and Foley catheter out of the way
  • ipsilateral arm on stack of blankets over chest and taped down, contralateral arm on arm board
  • prep and drape entire leg up to iliac crest to make sure adequate working area
  • c-arm from contralateral side at 45° towards hip
  • take initial fluoro AP/Lat of hip to examine femoral neck
  • mark position of C-arm to ensure proper positioning during remainder of case (~15° tilt for correct AP xray of hip)

Closed Reduction


Perform a closed reduction

  • apply gentle traction and internal rotation under fluoroscopic control


Verify the reduction is anatomic

  • reduction is considered anatomic when the normal contours of the femoral neck have been re-established in both the AP and lateral views, the normal neck-shaft angle and neck length are restored
  • the relative heights of the femoral head and trochanter should be symmetrical to the contralateral side and no gaps are seen in the fracture

Guidewire Placement


Position the guidewires

  • these should be in line with the femoral neck axis through poke holes
  • the standard placement is 3 pins in an inverted triangle position


Place guidepins

  • place guidepins through stab incisions

Screw Placement


Place screws

  • place cannulated screws over the guidepins
  • the pin must lie along the axis of the femoral neck in both the AP and lateral views and parallel to the anteversion pin
  • place the screws peripherally in the femoral neck with good cortical butrress
  • espescially in the inferior and posterior neck
  • avoid points below the lesser trochanter due to risk of subtrochanteric fracture postoperatively


Verify position of screws

  • verify the position in two planes by fluoroscopy


Drill screws

  • spread the soft tissues down to bone
  • place self drilling, self tapping cannulated screws by power over the guidewires
  • use washers in more proximal, metaphyseal locations


Confirm the length of the screws is appropriate

  • the screws should be long enough so that all screw threads are on the proximal (head) side of the fracture

Wound Closure


Irrigation and hemostasis

  • copiously irrigate the wounds


Close the skin

  • subcutaneous and skin closure with 2-0 vicryl and staples
Postoperative Patient Care
Private Note

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