Table 2 – Summary of Surgical Options for NOF Fractures *consider total hip arthroplasty in systemically well patient who was living independently prior to injury **can also consider hip hemiarthoplasty or total hip arthroplasty The titanium rod is placed through the medullary cavity of the femur for stabilisation Three parallel screws in an inverted triangle formation The lag screw is able to slide through the sideplate, allowing for compression and primary healing of the bone Replacement of the femoral head and neck via a femoral component fixed in the proximal femurĬonsists of a lag screw into the neck, a sideplate, and bicortical screws. This can be either as opioid analgesia and / or regional analgesia (such as a fascia-iliaca block)ĭefinitive management is surgical (Table 1), however the specific procedures depending on the type of fracture sustained, amongst several other factors Initial management of a neck of femur fracture should consist of an A to E approach to stabilise the patient and treat any immediately life- or limb- threatening problems, as this cohort of patients will likely sustain concurrent injuries (even in low-impact cases).Įnsure adequate analgesia is provided, as hip fractures are very painful. *If there remains clinical equipoise about the diagnosis, repeat plain films whilst manually applying traction to the affected leg or (more commonly) a CT hip may be warranted. As mentioned, further work-up as to the cause of the fall is also essential. Obtain full length femoral radiographs too, if there is suspicion of a pathological fracture.īasic routine blood tests, including FBC, U&Es, and coagulation screen, are required alongside a Group and Save if a long lie time could have occurred, a creatinine kinase (CK) level would be recommended to assess for any significant rhabdomyolysis.Ī urine dip, chest radiograph (CXR), and ECG are all useful in complete assessment of the older patient group, especially for pre-operative assessment and peri-operative management. 4), useful to assess the contralateral normal hip for pre-operative planning and templating*. Initial plain-film radiographic imaging should include antero-posterior (AP) and lateral views of the affected hip, as well as an AP pelvis (Fig. Table 1 – The Garden Classification for Intracapsular Hip Fracture Intracapsular fractures can also be further classified by the Garden Classification (Table 1) *There is supply in the early days of life from the ligamentum arteriosum, which lies within the ligamentum teres, however this dramatically reduces in size in later life, and is of negligible importance in adults Patients with a displaced intra-capsular fracture therefore require joint replacement (arthroplasty), rather than fixation. This is predominantly through the medial circumflex femoral artery, which lies directly on the intra-capsular femoral neck.Ĭonsequently, displaced intra-capsular fractures disrupt the blood supply to the femoral head and, therefore, the femoral head will undergo avascular necrosis (even if the hip is fixed). The blood supply to the neck of the femur is retrograde*, passing from distal to proximal along the femoral neck to the femoral head. Sub-tronchanteric, which are from the lesser trochanter to 5cm distal to this point.Inter-trochanteric, which are between the greater trochanter and the lesser trochanter.Extra-capsular – outside the capsule, subdivided into:.Intra-capsular – from the subcapital region of the femoral head to basocervical region of the femoral neck, immediately proximal to the trochanters. The neck of femur can be considered to have two distinct areas, which are described relative to the joint capsule: 1).įigure 1 – The bony landmarks of the anterior proximal femur Neck of femur (NOF) fractures can occur anywhere from the subcapital region of the femoral head to 5cm distal to the lesser trochanter (Fig. In this article, we will look at the classification, anatomy, clinical and radiological features, and management of neck of femur fractures. Neck of femur fractures are typically caused either by l ow energy injuries (the most common type), such as a fall in frail older patient, or h igh energy injuries, such as a road traffic collision or fall from height and are often associated with other significant injuries. The mortality of a femoral neck fracture up to 30% at one year consequently, these fractures require specialist care and, indeed, most orthopaedic units now have dedicated orthogeriatricians who specialise in the care of this vulnerable patient group. Over 65,000 hip fractures each year are recorded in the UK and they are becoming increasingly frequent due to an aging population. A fractured neck of femur (NOF) is a very common orthopaedic presentation.
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