#Femoral neck fracture free#
If the hip joint is free of osteoarthritic findings, a diagnosis of impending stress fracture should be considered.
Always be certain to order a true lateral radiograph of the hip because it will often show a fracture not visible on the plain AP or frog-leg AP view. If a patient does not have a history of falling but complains of pain in the groin aggravated by walking and weight bearing, rule out hip osteoarthritis with a weight-bearing radiograph. Because of this tenuous blood supply, all femoral neck fractures should be monitored for the development of avascular necrosis, even if a prosthesis is placed. Because the femoral neck (most of it) is intracapsular, the greater the displacement, the greater the risk of vascular compromise. Occasionally, these fractures are nondisplaced and can be treated with pinning. Most of these fractures are displaced therefore appropriate treatment is prosthetic replacement (one-half of a total hip). As the fracture completes itself, it results in the instability that causes the patient to fall. In most cases an osteoporotic femoral neck fracture is actually a stress fracture, which ultimately becomes complete. The hip suddenly gives way, and the patient falls to the floor no history of tripping over a carpet, pet, or step is usually reported, and the patient does not know the reason for the fall. For a younger person to sustain a femoral neck fracture from trauma takes significant force therefore most of these fractures occur in older osteoporotic patients, often while just walking in the home. 178.2 ) is the second most common type of hip fracture. Fowler MD, in Pfenninger and Fowler's Procedures for Primary Care, 2020 Femoral Neck Fractureįracture of the femoral neck (see Fig. Avascular necrosis (death of part of the bone owing to lack of blood supply) can occur as the blood supply to the head of the femur may be impaired following a fractured neck of femur ( Figure 22.20). The blood supply to the femoral head is predominantly via a periarticular anastomosis ( Palastanga et al. Both the last two procedures are likely to involve a weight-bearing restriction for the patient on the affected side until the bone becomes stronger. Garden type 1) fractures may be managed by cannulated screw fixation. Subtronchanteric fractures are routinely fixed with a proximal femoral nail. This allows dynamic movement at the fracture site which stimulates healing – more so when patients weight-bear through the affected limb. For more active older people who have fewer comorbidities, orthopaedic surgeons are increasingly choosing to fix the fracture with a total hip replacement.įor extracapsular fractures, where the blood supply is not impaired, a compression screw plate called a ‘dynamic hip screw’ is used. This is the method of choice for displaced fractures because of the dangers of avascular necrosis and because of the benefits of early mobilisation, which is so important in the frail. For intracapsular fractures the usual method is to excise the head and perform total hip replacement arthroplasty, although a hemiarthroplasty is still used in some patients ( Figure 22.19). Displaced fractures will need operative fixation. Occasionally, the fragments are impacted in slight abduction and the patient may be able to get up and walk after the injury. The resulting fracture is usually displaced with lateral rotation of the femoral shaft so that the leg will be laterally rotated and shortened in comparison with the other limb. Osteoporosis is often referred to as the silent epidemic as it may not present any clinical signs until fracture. In other words the fracture caused the fall, not the fall the fracture. The architecture of the bone may have been so weakened that patients say that they ‘heard a crack’ before they hit the ground. They are also referred to as Garden's classification however, this terminology is not as current as it was but may still be present in the literature.įemoral neck fractures are extremely common in the elderly, often following falls, and most orthopaedic units will have a number of these fractures at any one time. Femoral neck fractures should be described/classified by its location, for example basicervical and whether it is intracapsular or extracapsular, as this has a bearing on the surgical fixation chosen ( Figure 22.18).
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