Podcast
Questions and Answers
What is the most common age group affected by basal and basicervical fractures?
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?
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 is a common risk factor associated with basal and basicervical fractures post menopause?
What does ORIF stand for in the context of fracture treatment?
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?
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?
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?
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?
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?
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?
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.
