J Korean Hip Soc.  2010 Mar;22(1):13-19. 10.5371/jkhs.2010.22.1.13.

Femoral Neck Fracture

• Yoon HK
• Dan JM

• KMID: 1461072
• DOI: http://doi.org/10.5371/jkhs.2010.22.1.13

Abstract

The incidence of the femoral neck fracture is increasing, and the mechanism of the injuries is quite different in the young and elderly groups (high energy injury and osteoporosis, respectively). In the young group, early anatomical reduction and rigid fixation by such measures as multiple cannulated screws are mandatory to decrease the complications. In the elderly group, hip arthroplasty is recommended to decrease the complications due to early mobilization.

Keyword

Femoral neck fracture; Cannulated screws; Hemiarthroplasty

MeSH Terms

Aged
Arthroplasty
Early Ambulation
Femoral Neck Fractures
Femur Neck
Hemiarthroplasty
Hip
Humans
Incidence
Osteoporosis

Figure

• 

  Fig. 1 Bone density of cadaveric femoral heads.

• 

  Fig. 2 The arterial supply of the femoral head.

• 

  Fig. 3 Garden allignment index. An angle of 160° to 180° on both anteroposterior and lateral images was considered acceptable by Garden. Anatomic (left and middle) and unacceptable (right) reductions are shown.

• 

  Fig. 4 Anatomy of reduction. (A) Lowell demonstrated that the cortices of an anatomically aligned femoral head and neck will project shallow S- or reverse S-shaped curves on both X-ray views. (B) Malalignment is demonstraited by a flattening of one curve and a sharp apex on the opposite side.

• 

  Fig. 5 Configuration of pin fixation. (A) Cross-section showing the position of the screws in the femoral neck. Three screw inverted triangle configuration. (B) Four-screw diamond configuration.

• 

  Fig. 6 Preferred surgical technique of multiple cannulated screw fixation. (A) Fixed guides for triangle or diamond patterns. (B) AP projection of the placement of three parallel guide pins. (C) Lateral projection of three parallel guide pins. (D) The 6.5 mm cannulated screws of appropriate length are passed over the guide pins.

• 

  Fig. 7 Fixation of an femoral neck fracture with three parallel 6.5 mm screw in an inverted triangle configuration. (A) AP view. (B) Lateral view.

• 

  Fig. 8 Dynamic hip compression screw and sideplate with derotational screws.

Reference

1. Swiontkowski MF. Intracapsular fractures of the hip. J Bone Joint Surg Am. 1994. 76:129–138.

2. Koval KJ, Aharonff GB, Rosenberg AD, Schmigelski C, Bernstein RL, Zuckerman JD. Hip fracture in the elderly: the effect of anesthetic technique. Orthopaedics. 1999. 22:31–34.

3. Rodríguez-Merchán EC. In situ fixation of nondisplaced intracapsular fracture of the proximal femur. Clin Orthop Relat Res. 2002. 399:42–51.

4. Strömqvist B, Nilsson LT, Egund N, Thorngren KG, Wingstrand H. Intracapsular pressures in indisplaced fractures of the femoral neck. J Bone Joint Surg Br. 1988. 70:192–194.

5. Bosch U, Schreiber T, Krettek G. Reduction and fixation of displaced intracapsular fractures of the proximal femur. Clin Orthop Relat Res. 2002. 399:59–71.

6. Whitman R. The abduction method. Considered as the exponent of a treatment for all forms of fracture at the hip in accord with surgical principles. Am J Surg. 1933. 21:335–349.

7. Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961. 43:647–663.

8. Lowell JD. Results and complications of femoral neck fractures. Clin Orthop Relat Res. 1980. 152:162–172.

9. Schmidt AH, Asnis SE, Haidukewych G, Koval KJ, Thorngren KG. Femoral neck fracture. Instr Course Lect. 2005. 54:417–445.

10. Leadbetter GW. A treatment for fracture of the neck of the femur. J Bone Joint Surg Am. 1933. 15:931–940.

11. Robinson CM, Saran D, Annan IH. Intracapsular hip fractures. Results of management adopting a treatment protocol. Clin Orthop Relat Res. 1994. 302:83–91.

12. Asnis SE, Wanek-Sgaglione L. Intracapsular fracture of the femoral neck. Results of cannulated screw fixation. J Bone Joint Surg Am. 1994. 76:1793–1803.

13. Bray TJ. Femoral neck fracture fixation. Clinical decision making. Clin Orthop Relat Res. 1997. 339:20–31.

14. Kyle RF. Operative techniques of fixation for femoral neck fractures in young adults. Techniques in Orthopaedics. 1986. 1:33–38.