Case

• History
• Woman
• 89 years
• HTN (CoAprovel)
• Osteoporotic
• ER: fall
• No LOC
• No head trauma/associated trauma
Case
• Rx:
• subcapital femoral neck fracture
Case
• Physical exam
• Cardio thoracic: normal
• Ortho: Left leg in external rotation and abduction, with shortening
• Pulses: normal
• Neurological exam of the Left Leg: normal
• Sesitivity: normal
• Motricity:
• Plantarflexion: normal
• Dorsiflexion: normal
Femoral neck
fracture
Joeffroy Otayek
Femoral neck fracture
• Introduction
• Prognosis
• Anatomy
• Classification
• Symptoms
• Physical exam
• Complications
• Treatment
Introduction
• Epidemiology
• increasingly common due to aging population
• women > men
• most expensive fracture to treat on per-person basis

• Mechanism
• high energy in young patients
• low energy falls in older patients
Introduction
• Pathophysiology
• healing potential
• femoral neck is intracapsular, bathed in synovial fluid
• lacks periosteal layer
• callus formation limited, which affects healing

• Associated injuries
• femoral shaft fractures
• 6-9% associated with femoral neck fractures
• treat femoral neck first followed by shaft
Prognosis

• mortality~25-30% at one year

• predictors of mortality:
• pre-injury mobility is the most significant determinant for post-operative
survival
• in patients with chronic renal failure, rates of mortality at 2 years
postoperatively, are close to 45%
 Anatomy
• Blood supply to femoral head

• major contributor is medial

femoral circumflex (lateral
epiphyseal artery)

• some contribution to
anterior and inferior head
from lateral femoral
circumflex

• some contribution from

inferior gluteal artery

• small and insignificant

 Anatomy
• displacement of femoral
neck fracture will disrupt
the blood supply and
cause an intracapsular
hematoma
Classification

Subcapital Transcervical Basicervical

Classification
Case
• Rx: subcapital femoral neck fracture
Case

• Garden 3
Symptoms
• impacted and stress fractures
• slight pain in the groin or pain referred along the medial side of the thigh and
knee

• displaced fractures
• pain in the entire hip region
Physical Exam
• impacted and stress fractures
• no obvious clinical deformity
• minor discomfort with active or passive hip range of motion, muscle spasms
at extremes of motion
• pain with percussion over greater trochanter

• displaced fractures
• leg in external rotation and abduction, with shortening
Complications
Type Complication
Subcapital Avascular necrosis

Pertrochanteric Instability

Subtrochanteric Pseudarthrosis
Complications
Type Complication
Subcapital Avascular necrosis

Pertrochanteric Instability

Subtrochanteric Pseudarthrosis
Treatment

Surgery: When?
Treatment

Always!
Immobilization complications
Surgical
treatment
• Garden 1 – 2
• Open Reduction Internal
Fixation (ORIF)

• Garden 3 – 4
• Young: ORIF
• > 65: Total Hip Replacement
Surgical treatment
Take home messages
• Physical Exam: leg in external rotation and abduction, with shortening (Anthalgic Position)

• Classification for Femoral Neck Fracture: Garden Classificaiton

• Always search for arterial damage

• Surgical treatment: ALWAYS

• ORIF
• THR
Thank you