nondisplaced fractures may be subtle on x-ray.femur often positioned in flexion and external rotation (due to unopposed iliopsoas).lesser trochanter is more prominent due to external rotation of femur.Shenton’s line disruption: loss of contour between normally continuous line from medial edge of femoral neck and inferior edge of the superior pubic ramus.However, a recent study reports that thin-slice MDCT is as sensitive as MRI. In patients with a suspected occult NOF fracture, MRI (sensitivity 99-100%) is recommended by many institutions as the second-line test if available within 24 hours, with CT or nuclear medicine bone scan third-line. Plain radiographs (sensitivity 93-98%) is the first-line investigation for suspected NOF fractures. The mechanism in young patients is predominantly axial loading during high force trauma, with an abducted hip during injury causing a neck of femur fracture and an adducted hip causing a hip fracture-dislocation. There is generally deficient elastic resistance in the fractured bone. In elderly patients, the mechanism of injury various from falls directly onto the hip to a twisting mechanism in which the patient’s foot is planted and the body rotates. motor vehicle collisions) in younger patients įurther, severity of a subcapital fracture is graded by the Garden classification of hip fractures. While there is disagreement in the literature as to whether basicervical fractures are truly intracapsular or extracapsular, they should usually be treated like extracapsular fractures. Subcapital and transcervical fractures are considered intracapsular fractures. transcervical: midportion of femoral neck.Since disruption of blood supply to the femoral head is dependent on the type of fracture and causes significant morbidity, the diagnosis and classification of these fractures is important. Pathologyįemoral neck fractures are a subset of proximal femoral fractures. The femoral neck is the weakest part of the femur. In patients aged between 65 and 99, femoral neck and intertrochanteric fractures occur with approximately the same frequency. Incidence is increasing as the proportion of the elderly population in many countries increases. Elderly osteoporotic women are at greatest risk. Neck of femur fractures (NOF) are common injuries sustained by older patients who are both more likely to have unsteadiness of gait and reduced bone mineral density, predisposing to fracture.
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