Fractured Neck of Femur

Question 1

How are NOFs classified?

Answer 1

Intracapsular

• subcapital
• transcervical
• basicervical

Extracapsular

• intertrochanteric
• subtrochanteric

Question 2

What is the garden classification?

Answer 2

Further classify intracapsular fractures

I = non-displaced, incomplete
II = non-displaced, complete fracture
III = partial displacement
IV = full displacement

Question 3

Clinical features of #NOF

Answer 3

History of recent fall/trauma 
Significant pain in hip/groim/thigh
Inability to weight bear 
Leg shortened and externally rotated
Unable to straight leg raise

Full neurovascular exam essential

Question 4

Investigations for a suspected #NOF

Answer 4

X-ray

Bloods

• FBC
• U&Es
• clotting

Urine dipstick

Question 5

How do you report a #NOF x-ray?

Answer 5

Site of fracture

• side
• intra/extra capsular

Symmetry?
Joint spaces?
Shenton’s line?

Question 6

Management of a subcapital NOF?

Answer 6

Hip hemiarthroplasty

- replacement of femoral head and neck

Question 7

Management of an intratrochanteric/basocervical NOF

Answer 7

Dynamic hip screw

• lag screw in NOF, a sideplate and cortical screws
• lag screw slides through sideplate
• allows for compression and primary healing

Question 8

Management of a non-displaced intracapsular NOF

Answer 8

Cannulated hip screws

- 3 non-parallel screws in inverted triangle formation

Question 9

Management of subtrochanteric NOF

Answer 9

Intramedullary femoral nail

• metal rod placed through medullary cavity of femur
• allows for stabilisation

Question 10

Complications of #NOF

Answer 10

Blood supply damage

• medial femoral circumflesx artery
• unidirectional
• lies over femoral neck
• vulnerable to damage