Neck of femur fracture

Neck of femur (hip) fractures are divided into intracapsular fractures, which threaten the blood supply to the femoral head, and extracapsular (intertrochanteric and subtrochanteric) fractures.

Clinical presentation

An older patient after a fall, unable to bear weight, with a shortened and externally rotated leg. Undisplaced fractures may allow walking and are easily missed.

Radiographic features

Plain radiograph

AP pelvis and a lateral hip view:

• A fracture line or sclerotic band across the femoral neck
• Disruption of Shenton's line
• Loss of the smooth cortical contour and trabecular pattern
• The Garden classification grades intracapsular fractures from incomplete (I) to fully displaced (IV)

MRI and CT

MRI is the test of choice for an occult fracture when films are normal but suspicion remains; CT is an alternative when MRI is not available.

Treatment and prognosis

Surgery within 36 hours is the standard. Undisplaced intracapsular and extracapsular fractures are fixed (for example with a dynamic hip screw); displaced intracapsular fractures are usually treated with hemiarthroplasty or total hip replacement. Orthogeriatric care improves outcomes.