Hip

Femoral Neck Fracture

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Femoral Neck Fracture, Intracapsular Hip Fracture, Subcapital Femur Fracture, Transcervical Femoral Neck Fracture

  • Pathophysiology
  1. Often results from minimal to no injury
  • Risk Factors
  • Diagnosis
  • Types
  • Garden Classification
  1. Non-displaced Fractures (20%)
    1. Type 1: Stress Fracture - Valgus impaction of head
    2. Type 2: Complete, non-displaced Fracture
  2. Displaced Fractures
    1. Type 3: Varus displacement of femoral head
    2. Type 4: Fracture fragments completely displaced
  • Management
  1. Regional Anesthesia
    1. Consider Fascia Iliaca Block in isolated Femoral Neck Fracture (without Coagulopathy or other contraindication)
  2. Non-displaced Fracture (Type 1 or 2)
    1. Bone impaction provides Fracture stability
    2. Bedrest results in 90% union
    3. Open reduction and Internal Fixation: 100% union
  3. Displaced Fracture (Type 3 or 4)
    1. Open reduction and Internal Fixation
      1. Lower morbidity (decreased blood loss and deep Wound Infection) when compared with arthroplasty
    2. Arthroplasty (acetabulum and femoral head replacement) or Hemiarthroplasty (femoral head replacement)
      1. Lower reoperation rates
      2. Lower risk of avascular necrosis and nonunion
      3. Faster recovery
    3. References
      1. Butler (2011) J Bone Joint Surg Am 93(12): 1104-15 [PubMed]
  • Complications
  1. Non-union
  2. Avascular Necrosis
    1. Types 3 and 4 confer 10% risk
  3. Osteomyelitis or Septic Arthritis of the hip
    1. Reduced risk with perioperative antibiotics
  4. Pulmonary Embolism
    1. Leading cause of death at 7 days post-Fracture
  • References
  1. Gurr in Marx (2002) Rosen's Emergency Med, p. 655-60
  2. Schmidt (2002) Orthop Clin North Am 33(1):97-111 [PubMed]