Midcervical (transcervical): midportion of femoral neck
Basicervical: base of femoral neck
Vertically oriented: usually from superolateral to inferomedial, traversing all zones
Terms varus & valgus are used both for relationships of femoral head-neck, & of femoral neck-shaft
Alignment of femoral neck is relative to normal neck-shaft angle of 120-135°
Varus alignment: < 120° neck-shaft angle
Valgus alignment: > 135° neck-shaft angle
Femoral head should be centered on femoral neck
Varus alignment: femoral head rotates medially
Valgus alignment: femoral head rotates laterally
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Rogers NB et al: Improving the diagnosis of ipsilateral femoral neck and shaft fractures: a new imaging protocol. J Bone Joint Surg Am. 102(4):309-14, 2020
Steele CE et al: Femoral neck stress fractures: MRI risk factors for progression. J Bone Joint Surg Am. 100(17):1496-502, 2018
Hak DJ et al: Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics. 38(4):247-51, 2015
Haubro M et al: Sensitivity and specificity of CT- and MRI-scanning in evaluation of occult fracture of the proximal femur. Injury. 46(8):1557-61, 2015
Sheehan SE et al: Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics. 35(5):1563-84, 2015
Broderick JM et al: Osteoporotic hip fractures: the burden of fixation failure. ScientificWorldJournal. 2013:515197, 2013
Chiavaras MM et al: The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons. Skeletal Radiol. 42(8):1079-88, 2013
Lee YK et al: Trends of surgical treatment in femoral neck fracture: a nationwide study based on claim registry. J Arthroplasty. 28(10):1839-41, 2013
Manenti G et al: Diffusion tensor imaging and magnetic resonance spectroscopy assessment of cancellous bone quality in femoral neck of healthy, osteopenic and osteoporotic subjects at 3T: preliminary experience. Bone. 55(1):7-15, 2013
Davidovitch RI et al: Challenges in the treatment of femoral neck fractures in the nonelderly adult. J Trauma. 68(1):236-42, 2010
Kettunen JA et al: Hip fractures and femoral bone mineral density in male former elite athletes. Bone. 46(2):330-5, 2010
Aleem IS et al: Arthroplasty versus internal fixation of femoral neck fractures: a clinical decision analysis. Ortop Traumatol Rehabil. 11(3):233-41, 2009
Rehan-Ul-Haq et al: Pipkins type II fracture dislocation of the hip presenting as chondrolysis. J Orthop Sci. 14(4):459-64, 2009
Schemitsch E et al: Femoral neck fractures: controversies and evidence. J Orthop Trauma. 23(6):385, 2009
Schmidt AH et al: Optimal arthroplasty for femoral neck fractures: is total hip arthroplasty the answer? J Orthop Trauma. 23(6):428-33, 2009
Talbot JC et al: Femoral neck stress fractures in military personnel—a case series. J R Army Med Corps. 154(1):47-50, 2008
Bjorgul K et al: Incidence of hip fracture in southeastern Norway : a study of 1,730 cervical and trochanteric fractures. Int Orthop. 31(5):665-9, 2007
Parker MJ et al: Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res. 458:175-9, 2007
Dharmarajan TS et al: Hip fracture. Risk factors, preoperative assessment, and postoperative management. Postgrad Med. 119(1):31-8, 2006
Hagino T et al: Prognosis of proximal femoral fracture in patients aged 90 years and older. J Orthop Surg (Hong Kong). 14(2):122-6, 2006
Holmberg AH et al: Risk factors for fragility fracture in middle age. A prospective population-based study of 33,000 men and women. Osteoporos Int. 17(7):1065-77, 2006
Johnell O et al: An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 17(12):1726-33, 2006
Lesic A et al: Epidemiology of hip fractures in Belgrade, Serbia Montenegro, 1990-2000. Arch Orthop Trauma Surg. 2006
Lofthus CM et al: Young patients with hip fracture: a population-based study of bone mass and risk factors for osteoporosis. Osteoporos Int. 17(11):1666-72, 2006
Newman JS et al: MRI of the painful hip in athletes. Clin Sports Med. 25(4):613-33, 2006
Orwig DL et al: Hip fracture and its consequences: differences between men and women. Orthop Clin North Am. 37(4):611-22, 2006
Pihlajamaki HK et al: Displaced femoral neck fatigue fractures in military recruits. J Bone Joint Surg Am. 88(9):1989-97, 2006
Sorbie C: Sub-capital hip fracture: best treatment options. J Orthop Surg (Hong Kong). 14(3):237-9, 2006
Tidermark J et al: Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial. J Bone Joint Surg Br. 85(3):380-8, 2003
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Definitions
Subdivided according to location of fracture
Subcapital: femoral head-neck junction
Midcervical (transcervical): midportion of femoral neck
Basicervical: base of femoral neck
Vertically oriented: usually from superolateral to inferomedial, traversing all zones
Terms varus & valgus are used both for relationships of femoral head-neck, & of femoral neck-shaft
Alignment of femoral neck is relative to normal neck-shaft angle of 120-135°
Varus alignment: < 120° neck-shaft angle
Valgus alignment: > 135° neck-shaft angle
Femoral head should be centered on femoral neck
Varus alignment: femoral head rotates medially
Valgus alignment: femoral head rotates laterally
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Rogers NB et al: Improving the diagnosis of ipsilateral femoral neck and shaft fractures: a new imaging protocol. J Bone Joint Surg Am. 102(4):309-14, 2020
Steele CE et al: Femoral neck stress fractures: MRI risk factors for progression. J Bone Joint Surg Am. 100(17):1496-502, 2018
Hak DJ et al: Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics. 38(4):247-51, 2015
Haubro M et al: Sensitivity and specificity of CT- and MRI-scanning in evaluation of occult fracture of the proximal femur. Injury. 46(8):1557-61, 2015
Sheehan SE et al: Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics. 35(5):1563-84, 2015
Broderick JM et al: Osteoporotic hip fractures: the burden of fixation failure. ScientificWorldJournal. 2013:515197, 2013
Chiavaras MM et al: The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons. Skeletal Radiol. 42(8):1079-88, 2013
Lee YK et al: Trends of surgical treatment in femoral neck fracture: a nationwide study based on claim registry. J Arthroplasty. 28(10):1839-41, 2013
Manenti G et al: Diffusion tensor imaging and magnetic resonance spectroscopy assessment of cancellous bone quality in femoral neck of healthy, osteopenic and osteoporotic subjects at 3T: preliminary experience. Bone. 55(1):7-15, 2013
Davidovitch RI et al: Challenges in the treatment of femoral neck fractures in the nonelderly adult. J Trauma. 68(1):236-42, 2010
Kettunen JA et al: Hip fractures and femoral bone mineral density in male former elite athletes. Bone. 46(2):330-5, 2010
Aleem IS et al: Arthroplasty versus internal fixation of femoral neck fractures: a clinical decision analysis. Ortop Traumatol Rehabil. 11(3):233-41, 2009
Rehan-Ul-Haq et al: Pipkins type II fracture dislocation of the hip presenting as chondrolysis. J Orthop Sci. 14(4):459-64, 2009
Schemitsch E et al: Femoral neck fractures: controversies and evidence. J Orthop Trauma. 23(6):385, 2009
Schmidt AH et al: Optimal arthroplasty for femoral neck fractures: is total hip arthroplasty the answer? J Orthop Trauma. 23(6):428-33, 2009
Talbot JC et al: Femoral neck stress fractures in military personnel—a case series. J R Army Med Corps. 154(1):47-50, 2008
Bjorgul K et al: Incidence of hip fracture in southeastern Norway : a study of 1,730 cervical and trochanteric fractures. Int Orthop. 31(5):665-9, 2007
Parker MJ et al: Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res. 458:175-9, 2007
Dharmarajan TS et al: Hip fracture. Risk factors, preoperative assessment, and postoperative management. Postgrad Med. 119(1):31-8, 2006
Hagino T et al: Prognosis of proximal femoral fracture in patients aged 90 years and older. J Orthop Surg (Hong Kong). 14(2):122-6, 2006
Holmberg AH et al: Risk factors for fragility fracture in middle age. A prospective population-based study of 33,000 men and women. Osteoporos Int. 17(7):1065-77, 2006
Johnell O et al: An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 17(12):1726-33, 2006
Lesic A et al: Epidemiology of hip fractures in Belgrade, Serbia Montenegro, 1990-2000. Arch Orthop Trauma Surg. 2006
Lofthus CM et al: Young patients with hip fracture: a population-based study of bone mass and risk factors for osteoporosis. Osteoporos Int. 17(11):1666-72, 2006
Newman JS et al: MRI of the painful hip in athletes. Clin Sports Med. 25(4):613-33, 2006
Orwig DL et al: Hip fracture and its consequences: differences between men and women. Orthop Clin North Am. 37(4):611-22, 2006
Pihlajamaki HK et al: Displaced femoral neck fatigue fractures in military recruits. J Bone Joint Surg Am. 88(9):1989-97, 2006
Sorbie C: Sub-capital hip fracture: best treatment options. J Orthop Surg (Hong Kong). 14(3):237-9, 2006
Tidermark J et al: Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial. J Bone Joint Surg Br. 85(3):380-8, 2003
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