NOF Fractures

FEMORAL NECK FRACTURES

Garden Classification
Type I : Incomplete/valgus impacted
Type II : Complete nondisplaced fracture
Type III : Complete fracture with partial displacement
Type IV : Completely displaced fracture




Mechanism of Injury
Low-energy trauma in elderly:
Direct : Fall on greater trochanter
Indirect : Muscle forces transmitted to the femoral neck due to a fall

High-energy trauma in younger patients:
Usually due to motor vehicle accident or fall from height
Examination
Painful hip movements
Affected hip externally rotated, flexed and shortened.
In high-energy trauma, beware of contralateral femoral fracture masking shortening of limb or ipsilateral femoral fracture 'correcting' external rotation
Exclude sciatic nerve injury

X-rays
AP view of pelvis and lateral view of affected hip

Management
Exclude associated fractures/life-threatening injuries in cases due to high-energy trauma
Exclude head injury, especially in elderly patients
FBC, U/E/Cr/Glu, PT/PTT, GXM 1 pint, CXR, ECG

Determine cause of fall in elderly patients: e.g. bleeding GIT causing anaemia / hypotension; AMI; CVA; poor eye-sights; slippery floor; tripping against objects, etc
Determine premorbid status and medical problems

For patients < 50 years old, keep NBM for emergency surgery
Femoral neck fractures in elderly patients do not generally require emergency surgery

Admit to Ortho Dept if no urgent medical/surgical problems
Admit to Surgical Dept if bleeding GIT, unstable head injury/haemorrhagic stroke
Admit to Medical Dept if uncontrolled hypertension, DKA/HHNK, AMI, new CVA, i.e. cases where medical conditions are more pressing, requiring urgent physician care