![]() ![]() Initial management of extracapsular neck of femur fractures Degree of shortening and degree of subtrochanteric extension where present ![]() Involvement of the trochanters themselves Acetabular/pelvic fractures (including pubic symphysis fractures)ĭescribing types of extracapsular neck of femur fractures.Severe osteoarthritis of the hip/fracture osteophytes.Intracapsular neck of femur fractures or femoral shaft fractures.a haematoma versus a haemarthrosis in intracapsular fractures).ĭifferential diagnosis of extracapsular neck of femur fractures There is often bruising around the joint as any bone haematoma is not contained within the joint capsule (i.e.The affected limb is often shortened (but less likely externally rotated).Pain in the groin radiating down to the thigh.Presentation of extracapsular neck of femur fractures This might account for their greater prevalence in what is a largely elderly age group They are more common in those with moderate to severe hip osteoarthritis, as this renders the intertrochanteric region an area of greater stress. Risk factors are similar to intracapsular fractures.Once again the cause is predominantly a direct trauma from a fall onto the affected hemipelvis.Risk factors for extracapsular neck of femur fractures As an entity (both intertrochanteric and subtrochanteric) extracapsular neck of femur fractures are almost twice as common as intracapsular fractures.Much like intracapsular fractures, these are most commonly a fracture of elderly, osteoporotic bone.A fracture must be no more than 5cm below the lesser trochanter, otherwise it is treated as a femoral shaft fractureĮpidemiology of extracapsular neck of femur fractures.along a line that connects the lesser and greater trochanters of the femur) or subtrochanteric (below the level of the lesser trochanter) – see pictures below These can be described as intertrochanteric (i.e.As such the risks of avascular necrosis of the femoral head or no longer a concern Extra capsular neck of femur fractures (#NOF) are fractures of the neck of the femur which occur outside the capsule of the hip joint.In general, stage I and II are stable fractures and can be treated with internal fixation (head-preservation), and stage III and IV are unstable fractures and hence treated with arthroplasty (either hemi- or total arthroplasty) 3.Hip Fractures: Extracapsular Neck of Femur Fracturesĭefinition of an extracapsular neck of femur fracture (#NOF) Garden stage IV: complete fracture, completely displacedįemoral head aligned normally in the acetabulum and its medial trabeculae are in line with the pelvic trabeculae Garden stage III: complete fracture, incompletely displacedįemoral head tilts into a varus position causing its medial trabeculae to be out of line with the pelvic trabeculae Medial group of femoral neck trabeculae may demonstrate a greenstick fracture Garden stage I: undisplaced incomplete, including valgus impacted fractures Garden described particular femoral neck and acetabular trabeculae patterns which can assist in recognizing differences within this classification system 2. It is simple and predicts the development of osteonecrosis 1,2. The Garden classification of subcapital femoral neck fractures is the most widely used. ![]()
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