Fracture (femoral neck)

Classically, this is a fracture of old age, affecting women in their eighth or ninth decade of life.

Hip fracture refers to a fracture occurring in the area between the edge of the femoral head and 5 centimetres below the lesser trochanter

• these fractures are generally divided into two main groups (1)
  
  
  • those above the insertion of the capsule of the hip joint are termed intracapsular, subcapital or femoral neck fractures
    
    
  • those below the insertion are extracapsular
    • the extracapsular group is split further into trochanteric (inter- or pertrochanteric and reverse oblique) and subtrochanteric

Usually the bone has been weakened by underlying disease - most commonly, osteoporosis but also osteomalacia, diabetes, alcoholism and other conditions associated with osteopenia.

There is usually a history of trauma but in severely weakened bone, direct injury may be trivial or absent.

Rarely, fractures of the femoral neck are seen in children.

Generally the fracture is displaced and unstable. If some of the fragments have been impacted then the patient may be able to walk with some pain and discomfort.

In the UK (1)

• hip fracture is a major public health issue due to an ever increasing ageing population
  
  
• about 70,000 to 75,000 hip fractures occur each year
  
  
• about 10% of people with a hip fracture die within 1 month and about one-third within 12 months. Most of the deaths are due to associated conditions and not to the fracture itself, reflecting the high prevalence of comorbidity

Notes:

• ocult hip fracture
  • magnetic resonance imaging (MRI) should be offered if hip fracture is suspected despite negative X-rays of the hip of an adequate standard
    • if MRI is not available within 24 hours or is contraindicated, consider computed tomography (CT)

Reference:

• NICE (May 2017). Hip fracture.