Femoral neck fracture: Difference between revisions
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==Background== | ==Background== | ||
*Common in older patients with osteoporosis; rarely seen in younger patients | *Common in older patients with osteoporosis; rarely seen in younger patients | ||
{{Femur fracture types}} | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 8: | Line 9: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Hip pain DDX}} | ||
== | ==Evaluation== | ||
''30% of patients with symptoms suggestive of fracture but negative x-rays have fracture on MRI'' | ''30% of patients with symptoms suggestive of fracture but negative x-rays have fracture on MRI'' | ||
{{Proximal femur fracture diagnosis}} | {{Proximal femur fracture diagnosis}} | ||
[[File:PMC2823202 ORT-1745-3674-80-303-g001.png|thumb|Anterior-posterior radiograph of a patient who sustained a Garden I–II femoral neck fracture.]] | |||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Specific Management=== | |||
*Ortho consult | *Ortho consult | ||
*Skeletal traction is contraindicated (may compromise femoral head blood flow) | *Skeletal traction is contraindicated (may compromise femoral head blood flow) | ||
Latest revision as of 18:26, 13 May 2021
Background
- Common in older patients with osteoporosis; rarely seen in younger patients
Femur Fracture Types
Proximal
- Intracapsular
- Extracapsular
Shaft
- Mid-shaft femur fracture (all subtrochanteric)
Clinical Features
- Typically minimal bruising (intracapsular)
- If fractured and displaced: externally rotated and shortened
- If non-displaced: patient may be ambulatory
Differential Diagnosis
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
- Hip bursitis
- Psoas abscess
- Piriformis syndrome
- Meralgia paresthetica
- Septic arthritis
- Obturator nerve entrapment
- Avascular necrosis of hip
Evaluation
30% of patients with symptoms suggestive of fracture but negative x-rays have fracture on MRI
- Consider AP pelvis in addition to AP/lateral views to compare contralateral side
- Consider MRI if strong clinical suspicion but negative x-ray
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Ortho consult
- Skeletal traction is contraindicated (may compromise femoral head blood flow)
Disposition
- Admit