182 PA RT T W O • SURGICAL PROCEDURES FOR FRACTURES
FEMUR
CHAPTER 69 Femoral Neck Fractures
INDICATIONS visualization is not adequate for anatomic reduction and place-
Candidates include animals with transverse and short oblique ment of implants.2
femoral neck fractures. Reduction: Place two Kirschner wires so they lie at the
most proximal and distal level of the fracture surface. Drive the
OBJECTIVES pins either from medial to lateral beginning at the fracture sur-
• To achieve anatomic reduction and rigid fixation of the face or from the lateral surface medially, to exit and lie flush at
fracture to allow early return to function the fracture surface (Plate 69B). Reduce the fracture, and drive
the Kirschner wires into the femoral epiphysis to maintain
ANATOMIC CONSIDERATIONS reduction (Plate 69C).
The femoral neck/femoral shaft junction in the frontal plane is Stabilization: Drill a thread hole through the femoral
known as the angle of inclination. This angle is normally 135 epiphysis with the appropriate-sized drill bit parallel to and
degrees and should be approximated when surgical reduction is centered between the Kirschner wires (see Plate 69C). Measure
performed. The normal angle of anteversion is 15 to 20 degrees the length of screw needed, and tap the thread hole. Insert a
and must be considered when inserting screws or pins into the partially threaded cancellous screw, 2 mm shorter than the
femoral neck.1 length measured, so that all the threads cross the fracture plane
and are seated into the femoral head. Leave one or both wires
EQUIPMENT in place to serve as antirotational devices (Plate 69D). Close the
• Surgical pack, Senn retractors, Gelpi retractors, Hohmann incision routinely.
retractors, Myerding retractors, periosteal elevator, Kirschner
wires, bone screws and instruments for inserting bone screws, CAUTIONS
high-speed drill and wire driver, wire cutter It is important to follow the anteversion angle of the femoral
neck with the implants and to avoid penetrating the articular
PREPARATION AND POSITIONING surface with Kirschner wires and the bone screw.
Prepare the rear limb circumferentially from dorsal midline to
mid-tibia. Position the animal in lateral recumbency, with the POSTOPERATIVE EVALUATION
affected limb up. Drape the limb out from a hanging position to Radiographs should be evaluated for reduction and implant
allow maximal manipulation during surgery. Prepare the ipsilat- position. Frog leg and extended hip views may help implant
eral wing of the ilium for cancellous bone graft harvest. position visualization.
PROCEDURE POSTOPERATIVE CARE
Approach: Incise the skin and subcutaneous tissue 5 cm The animal should be confined, with activity limited to leash
proximal to the greater trochanter, curving distally adjacent to walking. Radiographs should be repeated at 6-week intervals
the cranial ridge of the trochanter, and extending distally for until the fracture has healed.
5 cm over the proximal femur. Incise between the tensor fasciae
latae muscle and deep border of the biceps femoris muscle and EXPECTED OUTCOME
superficial gluteal muscle. Retract the tensor fasciae latae Bone healing is usually seen within 6 to 12 weeks. Instability at
cranially, the biceps caudally, and the middle gluteal muscle the fracture site can result in delayed union and implant failure.
proximally. Incise the deep gluteal tendon close to its attach-
ment on the trochanter for one third to one half of its width.
Incise the joint capsule parallel to the long axis of the femoral References
neck near its proximal ridge. Continue the joint capsule incision 1. Johnson AL, Hulse DA: Femoral metaphyseal fractures. In Fossum
laterally through the point of origin of the vastus lateralis TW (ed): Small Animal Surgery, 2nd ed. St. Louis, Mosby, 2002.
muscle on the cranial face of the proximal femur. Reflect the 2. Piermattei DL, Johnson KA: An Atlas of Surgical Approaches to the
vastus lateralis ventrally to visualize the fracture surface (Plate Bones and Joints of the Dog and Cat, 4th ed. Philadelphia, WB
69A).2 A greater trochanteric osteotomy may be required if Saunders, 2004.
CHAPTER 69 FEMORAL NECK FRACTURES 183
P L AT E 6 9
Tensor fasciae
latae muscle
retracted cranially
Deep gluteal
muscle
Middle gluteal muscle
retracted proximally
Vastus lateralis
muscle
Biceps femoris muscle
retracted caudally
