Neck of the femur fracture

Question 1

What are the two classifications of NOF

Answer 1

1. Intracapsular fractures - interrupt blood supply to femoral head if disturbed
2. Extracapsular fracture - lie outside capsule so blood supply is less likely to be distrupted

Question 2

Clinical features of a NOF fracture?

Answer 2

Shortened and externally rotated limb

Question 3

Ix for NOF fracture?

Answer 3

1. Plain X ray

2. MRI or Bone scan if radiographs are negative

Question 4

Principles of displaced neck of the femur fracture?

intracapsular fractures

Answer 4

Consider physiological age > chronological age and mobility status
1. Young pt - fix

2. High demand elderly - Total hip replacement
   - higher rate of complications as more invasive
3. Low demand elderly - Hemiarthroplasty
   - lower complication
   - early mobilisation

Question 5

How are NOF fractures fixed?

Answer 5

internal fixation with cannulation screws

Question 6

Mx of extracapsular fractures?

Answer 6

Blood supply is uninterrupted so extracapsular fractures are reduced and fixed with a dynamic hip screw

• allows patient to regain maximum mobility rapidly and weight bearing in 2-3 days

Question 7

What is the prognosis of NOF fractures?

Answer 7

1. 60% survive upto a year
2. 30% regain premordbid function
3. 20% never walk again