II. Pathophysiology

  1. Often results from minimal to no injury

III. Risk Factors

IV. Diagnosis

V. Types: Garden Classification

  1. Non-displaced Fractures (20%)
    1. Type 1: Stress Fracture - Valgus impaction of head
    2. Type 2: Complete, non-displaced Fracture
  2. Displaced Fractures
    1. Type 3: Varus displacement of femoral head
    2. Type 4: Fracture fragments completely displaced

VI. Management

  1. Non-displaced Fracture (Type 1 or 2)
    1. Bone impaction provides Fracture stability
    2. Bedrest results in 90% union
    3. Open reduction and Internal Fixation: 100% union
  2. Displaced Fracture (Type 3 or 4)
    1. Open reduction and Internal Fixation
      1. Lower morbidity (decreased blood loss and deep wound infection) when compared with arthroplasty
    2. Arthroplasty (acetabulum and femoral head replacement) or Hemiarthroplasty (femoral head replacement)
      1. Lower reoperation rates
      2. Lower risk of avascular necrosis and nonunion
      3. Faster recovery
    3. References
      1. Butler (2011) J Bone Joint Surg Am 93(12): 1104-15

VII. Complications

  1. Non-union
  2. Avascular Necrosis
    1. Types 3 and 4 confer 10% risk
  3. Osteomyelitis or Septic Arthritis of the hip
    1. Reduced risk with perioperative antibiotics
  4. Pulmonary Embolism
    1. Leading cause of death at 7 days post-Fracture

VIII. References

  1. Gurr in Marx (2002) Rosen's Emergency Med, p. 655-60
  2. Schmidt (2002) Orthop Clin North Am 33(1):97-111

Images: Related links to external sites (from Google)

Ontology: Femoral Neck Fractures (C0015806)

Definition (MSH) Fractures of the short, constricted portion of the thigh bone between the femur head and the trochanters. It excludes intertrochanteric fractures which are HIP FRACTURES.
Concepts Injury or Poisoning (T037)
MSH D005265
ICD9 820
ICD10 S72.0 , S72.00
SnomedCT 157233005, 5913000, 208520007
English Femoral Neck Fracture, Femoral Neck Fractures, NOF - Fracture neck of femur, Femur Neck Fracture, Femur Neck Fractures, fracture of neck of femur (diagnosis), fracture of neck of femur, Fractured femoral neck, Fractured neck of femur, FEMUR NECK FRACTURE, Fracture of neck of femur NOS, Femoral Neck Fractures [Disease/Finding], fracture femoral neck, femur fracture neck, femur neck fracture, neck of femur fracture, femoral neck fracture, femoral neck fractures, Fracture;neck of femur, femoral fracture neck, femur fractures neck, fracture neck femur, fracture neck of femur, fracture of neck femur, femoral fractures neck, femur fractured neck, fractured neck femur, Fracture of neck of femur, NOF - Fracture of neck of femur, Femoral neck fracture, Fracture of neck of femur (disorder), femur fracture; femur neck, femur neck; femoral fracture, femur; fracture, neck, fracture; femur, neck, fractured neck of femur
Italian Frattura del collo del femore, Collo femorale fratturato, Fratture del collo del femore
Dutch gebroken femurhals, fractuur van femurhals, femur; fractuur, hals, femurhals; heupfraktuur, fractuur; femur, hals, heupfraktuur; femurhals, femurhalsfractuur, Collum femorisfraktuur, Femurhals, fracturen van, Fracturen van femurhals, Fractuur van femurhals, Fractuur, femurhals-
French Col du fémur fracturé, Col fémoral fracturé, Fracture du col du fémur, Fractures du col fémoral, Fractures cervicales du fémur, Fractures du col du fémur
German Fraktur des Oberschenkelhalses, gebrochener Oberschenkelhals, gebrochener Hals des Oberschenkels, Schenkelhalsfraktur, Oberschenkelhalsfraktur, Schenkelhalsfrakturen, Fracturae colli femoris
Portuguese Colo do fémur fracturado, Fractura do colo do fémur, Fraturas do Colo Femoral
Swedish Lårbenshalsfrakturer
Japanese ダイタイコツケイブコッセツ, 骨折-大腿骨頸部, 大腿骨頸部骨折, 大腿骨頚部骨折, 大腿骨骨折-頸部
Czech femur - fraktury krčku, Zlomený krček femuru, Zlomený krček kosti stehenní, Zlomenina krčku femuru
Spanish Fracture of neck of femur, Cuello de fémur fracturado, fractura del cuello del fémur, fractura del cuello femoral (trastorno), fractura del cuello femoral, Fractura del cuello del fémur, Fracturas del Cuello Femoral
Finnish Reisiluunkaulan murtumat
Korean 넓적다리경부의 골절
Polish Złamania szyjki kości udowej
Hungarian Combnyaktörés

Ontology: Fracture of unspecified intracapsular section of neck of femur, closed (C0159811)

Concepts Injury or Poisoning (T037)
ICD9 820.00
English Fracture of unspecified intracapsular section of neck of femur, closed, Fx femur intrcaps NOS-cl
Dutch fractuur van niet-gespecificeerd intracapsulair deel van femurhals, gesloten
French Fracture fermée d'une section intracapsulaire non précisée du col du fémur
German Fraktur eines unspezifischen intrakapsulaeren Abschnitts des Oberschenkelhalses, geschlossen
Italian Frattura chiusa di sezione intracapsulare non specificata del collo del femore
Portuguese Fractura fechada de parte intracapsular NE do colo do fémur
Spanish Fractura de sección intracapsular no especificada del cuello del fémur, cerrada
Japanese 大腿骨頚部部位不明の関節包内骨折、閉鎖性, ダイタイコツケイブブイフメイノカンセツホウナイコッセツヘイサセイ
Czech Zlomenina blíže neurčené intrakapsulární části krčku femuru, zavřená
Hungarian Combnyak intracapsularis részének nem meghatározott törése, zárt

Ontology: Other transcervical fracture of femur, closed (C0159815)

Concepts Injury or Poisoning (T037)
ICD9 820.09
Dutch andere transcervicale femurfractuur, gesloten
French Autre fracture transcervicale du fémur fermée
German sonstige transzervikale Fraktur des Oberschenkels, geschlossen
Italian Altra frattura transcervicale del femore, chiusa
Portuguese Outra fractura transcervical fechada
Spanish Otras fracturas transcervicales del fémur, cerradas
Czech Jiná transcervikální zlomenina femuru, zavřená
English Fx femur intrcaps NEC-cl, Other transcervical fracture of femur, closed
Hungarian Egyéb transcervicalis zárt femur-törés

Ontology: Subcapital fracture of neck of femur (C0347808)

Concepts Injury or Poisoning (T037)
ICD10 S72.01
SnomedCT 263226008
English Intrcapsr frac neck of femur, Subcapital frac neck of femur, FEMUR SUBCAPITAL FRACTURE, Subcapital fracture of femur, subcapital fracture of neck of femur, subcapital fracture femur, subcapital femur fracture, Intracapsular fracture of neck of femur, Subcapital fracture of neck of femur, Subcapital fracture of neck of femur (disorder)
Spanish fractura subcapital de cuello de fémur (trastorno), fractura subcapital de cuello de fémur