Femoral Fractures

Question 1

What are clinical features of a femoral neck fracture?

Answer 1

Pain in hip
Pain on passive movement esp rotation and leg raising
If displaced then leg is shortened and externally rotated

Question 2

What are the XR features of a femoral neck fracture?

Answer 2

AP and lateral pelvis XR
On AP look for fracture line asymmetry
On lateral look for angulation and fragmentation

Question 3

Why is the blood supply important in femoral neck fracture?

Answer 3

Femoral head gets its blood supply from 3 main sources

1) Intramedullary vessels that run inside the medullary canal
2) Medial and lateral circumflex artery anastomoses that run up to femoral head
3) Artery of ligamentum teres- makes up <10% of femoral head supply

Any fracture that interrupts the intramedullary blood supply and circumflex causes impaired blood flow to head of femur

Question 4

What are the 3 neck of femur fracture types to be aware of?

Answer 4

Intracapsular
Intertrochanteric
Subtrochanteric

Question 5

What is an intracapsular femoral neck fracture?

Answer 5

Commonly referred to as NOF

Occur just above intertrochanteric line

Question 6

What is the garden criteria for intracapsular fractures?

Answer 6

Used to grade the fractures based on the degree of displacement

1) Incomplete, impacted fracture head may tilt in valgus position
2) Complete fracture across neck but not displaced
3) Complete fracture some continuity between fracture ends and head remains slightly valgus
4) Complete fracture, no continuity of ends

Question 7

What is the management of an intracapsular fracture?

Answer 7

Depends on degree of displacement and fitness of patient

Garden 1/2= open reduction and internal fixation
-low risk of avascular necrosis so cannulated hip screws used

Garden 3/4=hemiarthroplasty due to high risk of avascular necrosis

If young/fit patient

• fracture screwed instead of hemiarthroplasty as numerous revisions will be needed
• If AVNs develop will tolerate revision surgery better
• patients that mobilise well should have complete arthroplasty as better outcomes

Conservative managemetn used if elderly etc.

Question 8

What is an intertrochanteric fracture?

Answer 8

Fracture lines between the trochanters and is extracapsular

No threat to blood supply

Question 9

What is the management of intertrochanteric fracture?

Answer 9

Dynamic hip screw

Fracture reduced on traction table in theatre and fixed

Question 10

What is subtrochanteric fracture?

Answer 10

Occurs below trochanter- extracapsular
No threat to blood supply

Occur in high trauma or due to lytic lesions

Managed with intramedullary nail and hip screw