Femoral neck fracture; cannulated screws
37 year old poorly coping woman who fell on her left hip, sustaining a valgus impacted fracture that was open along the inferomedial cortex approximately 2 mm, and definitely impacted superiorly.
Positioning: On fracture table, with feet in boots. The right leg was abducted almost to 90 degrees so that the left leg could be adducted – this was a key feature of the reduction.
The initial reduction didn’t look so good. Traction alone only made the valgus worse. Flexion definitely improved things, and internal rotation brought the inferomedial cortex to within 1 mm. The key was then to adduct the leg to get the cortex lined up.
The cannulated screws were then straightforward. The mistake made was that the first central screw was too low, so that the guide could not be used to put in two inferior screws. As it turns out, the guide is not very good at making the K-wires parallel, and it may be better to simply free hand each one, using the first one (which should be perfect) as the guide.
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