![]() ![]() History of tumours (primary or secondary bone tumours, breast, bowel, prostate, kidney, lung, thyroid tumours)Įlderly or confused patients may be unable to give a history of trauma (e.g.Visual impairment: which increases the risk of falls and subsequently fractures.History and risk factors of osteoporosis including menopause, amenorrhoea, smoking, excessive alcohol or caffeine intake, physical inactivity, long-term or high-dose corticosteroid use.Age (≥65 years in women and ≥75 years in men).Risk factors for neck of femur fracture include: The Pauwels classification of neck of femur fracture. The Pauwels classification (figure 3) classifies fractures according to the angle of the fracture line from horizontal:įigure 3. The Garden classification of neck of femur fractures. Stage IV: complete fracture line, complete displacementįigure 2.Stage III: complete fracture line, partial displacement.Stage II: complete fracture line, non-displaced.Stage I: incomplete fracture line or impacted fracture.The Garden classification (figure 2) classifies fractures according to the degree of displacement as seen on an AP radiograph: Classification of NOFF by anatomical location. Pathological fractures tend to be in the subtrochanteric region, which is subject to the most stress. These typically include intertrochanteric and subtrochanteric fractures, where the joint capsule is not damaged and the blood supply to the fracture site is sufficient, leading to better fracture healing and an improved prognosis. This can ultimately lead to avascular necrosis.Īs a result, intracapsular fractures have a high risk of avascular necrosis of the femoral head and non-union of the fracture.Įxtracapsular fractures are below the intertrochanteric line. The only intact artery supplying the femoral head in this situation is the artery within the ligamentum teres which is not enough to keep the femoral head viable. As a result, the blood supply from the femoral circumflex arteries and nutrient arteries inside the bone are disrupted. Anatomical locationĪ neck of femur fracture occurring proximal to the intertrochanteric line is intracapsular and involves damage to the joint capsule. Fractures can be classified by anatomical location or by the degree of displacement or angulation. The classification of neck of femur fractures is used to guide management. May be seen in younger patients due to long-term corticosteroid use, alcohol consumption or malnutrition. Reduced bone mineral density: osteopenia and osteoporosis.Pathological fractures: a fracture in a diseased bone (due to a tumour or infection).High energy trauma: may cause neck of femur fractures in younger patients.Other causes of neck of femur fractures include: 5, 6 The majority of neck of femur fractures occur in older patients because of low-energy trauma (e.g. The femoral circumflex arteries: encircle the femoral neck on top of the capsule.The femoral head receives blood supply from three arterial sources: ![]() The hip joint is stabilised by a capsule, which is formed of three ligaments: the iliofemoral, ischiofemoral and pubofemoral ligaments. You might also be interested in our surgical flashcard collection which contains over 500 flashcards that cover key surgical topics. ![]()
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