Neck of Femur Fracture:

• intracapsular = just below the femoral head but within the capsule, blood supply can be damaged
• extracapsular (intertraochanteric) = at level of or below trochanters, blood supply to hip usually intact
• patients present with hip pain + leg is usually shortened & external rotated

Garden’s classification for intracapsular hip fractures:

1. incomplete fracture of the neck
2. complete without displacement
3. complete with partial displacement, fragments are still connected by posterior retinacular attachment
4. complete femoral neck fracture with full displacement, the proximal fragment is free & lies correctly in the acetabulum so that the trabeculae (bone lines) appear normally aligned

• this classification mentions displacement which is relevant because the blood supply to the femoral head runs around the base of neck & goes from distal to proximal (femoral circumflex artery) leads to avascular necrosis in 30% of displaced & 10% of undisplaced fractures
• treatment: resus, analgesia, X-rays, blood (inc. clotting + group & save, i.e. prepare for surgery), keep nil by mouth (NBM), surgery (dynamic hip screw fixation if extracapsular or for more severe/intracapsular fractures a hemi/total hip replacement maybe needed)
• N.B. mortality over next year = 20-35%

	AP view of a R side NOF fracture
	Lateral view of same R sided NOF fracture
	Dynamic hip screw fixation (DHS)
	Hemiarthroplasty = metal prosthesis fits into a normal acetabulum
	Total hip replacement (THR) = a metal prosthetic socket is fitted into the acetabulum
	Canulated screw fixation of NOF fracture