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Questions and Answers
What is the most common age group affected by basal and basicervical fractures?
Which of the following is not a clinical feature of displaced fractures?
What is a common risk factor associated with basal and basicervical fractures post menopause?
What does ORIF stand for in the context of fracture treatment?
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Which treatment approach may be considered for non-ambulators with minimal pain and high surgical risk?
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What type of patient is ORIF indicated for in the context of basal and basicervical fractures?
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Which symptom is typically associated with impacted and stress fractures?
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What is a common cause of basal and basicervical fractures related to muscle health?
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What is a potential cause of basal and basicervical fractures related to endocrine health?
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What is the typical presentation of displaced fractures in terms of leg positioning?
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Study Notes
Basal/Cervical Fractures
- Occur mostly in the elderly (7th & 8th decade) due to weak muscles, poor balance, osteomalacia, diabetes, stroke, and chronic debilitating diseases.
- Common causes include falls from height, road traffic accidents, and minor trauma.
- Symptoms include slight pain in the groin or referred pain along the medial side of the thigh and knee in impacted and stress fractures.
- Physical exam may show no obvious clinical deformity, minor discomfort with active or passive hip range of motion, and muscle spasms at extremes of motion.
Treatment
- Non-operative observation alone may be considered in non-ambulatory patients with minimal pain and high risk for surgical intervention.
- Operative treatment involves Open Reduction and Internal Fixation (ORIF) for displaced fractures, especially in young or physiologically young patients.
Femoral Neck Fracture
Introduction
- The head and neck of the femur are structured for efficient transmission of body weight with minimum bone mass.
- Fracture of the neck of the femur is most common in elderly women, especially those over 70 years of age.
Epidemiology
- Incidence is high and increasing due to an aging population.
- Demographics show that women are more affected than men, and Caucasians more than African Americans.
- The United States has the highest incidence of hip fracture rates worldwide.
Surgical Anatomy
- The neck of the femur connects the Head of the Femur and the Shaft.
- It is cylindrical, projecting in a superior medial direction at an angle of approximately 135 degrees to the shaft.
- The neck has two borders and two surfaces, strengthened by the calcar femorale.
Risk Factors
- Female sex
- White race
- Increasing age
- Poor health
- Tobacco and alcohol use
- Previous fracture
- Fall history
- Low estrogen level
Pathogenesis & Mechanism of Injury
- The femoral neck has limited healing potential due to its intracapsular location, lack of periosteal layer, and limited callus formation.
- Associated injuries include femoral shaft fractures (6-9% associated with femoral neck fractures), which should be treated first.
- Fracture location can be classified into intracapsular (sub-capital and trans-cervical) and extracapsular types.
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Description
Learn about the structure of the femoral neck, common occurrence in elderly women, risks such as avascular necrosis, and more in this introductory quiz.
