Fracture – Neck of Femur- Classifications, Symptoms, Importance, Clinical Features And Aim of Treatment

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Fracture – Neck of Femur:

Importance:

Fracture of the neck of femur is an orthopaedic emergency. With such high advances in the field of medicine, this condition still poses as a problem still to be solved. This is mainly because of the complications like non – union, avascular necrosis etc., are more common in fracture of neck of femur.

The causes are,

  • Intra capsular area of neck of femur lacks cambium layer. Hence there is no peripheral callus formation and only endosteal callus is formed.

  • The initial haemotoma which is very much essential for fracture healing, is lysed by the synovial fluid.

  • Dislocation of fracture may result in avascularity of the fractured fragment.

Incidence:

This fracture is more common in elderly people. It is common in conditions of osteoporosis, osteomalacia etc.  In elderly women osteoporosis due to senility and hormonal changes is the main cause.

Mode of injury:

A trivial fall can cause a blow to the greater trochanter which results in this fracture. A lateral rotational injury can also cause this fracture. This is common in road traffic accidents.

Classifications:

Broad classification:

  • Intra – capsular fracture

  • Extra – capsular fracture

Structural classification:

  • Impacted fracture

  • Non – displaced fracture

  • Displaced fracture

Etiological classification:

  • Stress fracture

  • Pathological fracture

  • Post – irradiation fracture

Anatomical classification:

  • Sub – capital fracture.

  • Trans cervical fracture.

  • Basal fracture.

Garden classification:

  • Incomplete fracture

  • Complete fracture without displacement.

  • Complete fracture with partial displacement

  • Complete fracture with total displacement.

Delbet classification:

  • Trans epiphyseal fracture.

  • Trans cervical fracture.

  • Cervico trochanteric fracture.

  • Inter trochanteric fracture.

  • Per trochanteric fracture.

Further Pauwels and Perlingtons classification according to the fracture angle are used to classify neck of femur fractures.

Clinical features:

Pain, tenderness, swelling and restricted movements of the hip joint are present. There will be shortening and external rotation deformity. In impacted fractures there will bew minimal groin pain, antalgic gait and restriction of movements.

Radiological features:

Fracture line will be seen. Angle of fracture can be asssessed

Shentons line will be broken

Posterior communition if present will be seen only in the lateral view.

Goals of treatment:

Anatomical reduction

Impaction of fragments

Rigid internal fixation.

Surgery is the choice in many cases. Osteotomy, arthroplasty and total hip replacements may be needed.

 

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