Neck of femur fracture
| Headline | |
|---|---|
| Etiology | Mechanism often trivial, combined with osteoporosis. |
| Epidemiology | Risk factors for falls Risk factors for osteoporosis: |
| Clinical presentation | |
| Pathogenesis | |
| Diagnostic investigations | CT hip not seen on XR XR pelvis: hopefully |
| Management | See Garden classification below. Delayed fixation = risk of osteonecrosis. |
radiographic signs
copied shamelessly from Radiopedia
- Disruption of Shenton's line
- lesser trochanter is more prominent due to external rotation of femur
- femur often positioned in flexion and external rotation (due to unopposed iliopsoas)
- asymmetry of lateral femoral neck/head
- sclerosis in fracture plane
- smudgy sclerosis from impaction
- bone trabeculae angulated
- non-displaced fractures may be subtle on x-ray
Garden classification
Based on AP views only
- Type I - incomplete fracture, valgus impacted
- Type II - complete fracture, nondisplaced
- Type III - complete fracture, partially displaced - femoral head tilts into varus
- Type IV - complete fracture, fully displaced
- Type III and IV = unstable, need arthroplasty
management - depends on type of fracture
- Intracapsular
- undisplaced: internal fixation
- displaced: THR > hemiarthroplasty in patients with better mobility
- Intertrochanteric: DHS, intramedullary nail
- Subtrochanteric: intramedullary nail