The hip is a common site of fracture, especially in osteoporotic, elderly females. The blood supply to the femoral head runs up the neck and thus avascular necrosis is a risk in displaced fractures.

Features

• pain
• the classic signs are a shortened and externally rotated leg
• patients with non-displaced or incomplete neck of femur fractures may be able to weight bear

Classification

Location

• intracapsular (subcapital): from the edge of the femoral head to the insertion of the capsule of the hip joint
• extracapsular: these can either be trochanteric or subtrochanteric (the lesser trochanter is the dividing line)

Intracapsular vs extracapsular hip fractures.

The Garden system is one classification system in common use.

• Type I: Stable fracture with impaction in valgus
• Type II: Complete fracture but undisplaced
• Type III: Displaced fracture, usually rotated and angulated, but still has boney contact
• Type IV: Complete boney disruption

Blood supply disruption is most common following Types III and IV.

Management

Intracapsular hip fracture