Femoral Neck Fractures

Question 1

What is the most expensive fracture to treat on a “per-person” basis?

Answer 1

femoral neck fxs
US has highest incidence
Women>men
Whites>blacks

Question 2

What is the incidence of femoral neck fxs in femoral shaft fxs?

Answer 2

6-9%

Fix femoral neck, then femoral shaft

Question 3

What is the normal neck shaft angle for the femur and normal anteversion?

Answer 3

neck-shaft angle: 130 +/- 7

Anteversion: 10 +/- 7

Question 4

What imaging modality can help identify occult femoral neck fractures?

Answer 4

MRI

Question 5

What is the advantage of THA over hemiarthroplasty in the treatment of a femoral neck fx?

Answer 5

1) more predictable pain relief
2) improved functional hip scores
3) lower re-operation rates

Question 6

What is the 30-day mortality a/w femoral neck fractures?

Answer 6

If treated within 4 days from injury: 7.3%
Treated after 4 days: 10%
Acute medical comorbidity delaying surgery: 17%

Question 7

Which cannulated screw configurations used in the treatment of subcapital femoral neck fractures is optimal?

Answer 7

Inverted triangle pattern with the inferior screw posterior to midline and adjacent to the calcar
4-screw configuration considered if posterior comminution

Question 8

In a young patient that underwent ORIF for a displaced femoral neck fracture, what is the most common complication?

Answer 8

AVN or osteonecrosis (10-45%)

Can treat with either free vascularized fibular graft or THA

Question 9

Which type of malreduction is a/w failure of ORIF in femoral neck fractures?

Answer 9

Varus; can lead to non-union

Treated with valgus intertrochanteric osteotomy

Question 10

What is the most significant determinant of post-op survival after a femoral neck fx?

Answer 10

Pre-op mobility
1-yr mortality is 14-36%; normal for age thereafter
2-yr mortality with CRF is ~45%

Question 11

What is the Timed Up and Go test useful for?

Answer 11

Indicates probability of independent walking without assistive device at 2-yr f/u after a femoral neck fx

Question 12

In patients with femoral neck fractures that present to the hospital 2-3 days after injury, what procedure should be added to pre-operative work up?

Answer 12

Duplex US of lower extremities

Higher risk of DVT with long immobilization

Question 13

What injury is anticipated to have a 20% chance of mortality and 50% chance of loss of independence at one year when sustained by an 85-year-old female?

Answer 13

femoral neck fracture