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)

TheGarden systemis 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.

Intracapsular hip fracture

Undisplaced Fracture:

• internal fixation, or hemiarthroplasty if unfit.

Displaced Fracture:

• NICE recommend replacement arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture
• total hip replacement is favoured to hemiarthroplasty if patients:
  • were able to walk independently out of doors with no more than the use of a stick and
  • are not cognitively impaired and
  • are medically fit for anaesthesia and the procedure.

Extracapsular hip fracture

Management

• stable intertrochanteric fractures: dynamic hip screw
• if reverse oblique, transverse or subtrochanteric fractures: intramedullary device