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Femoral Neck Fracture
Julia R. Crim, MD
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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 to neck, & of femoral neck to 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

                                            1. Hak DJ et al: Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics. 38(4):247-51, 2015
                                            2. 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
                                            3. Sheehan SE et al: Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics. 35(5):1563-84, 2015
                                            4. 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
                                            5. 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
                                            6. 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
                                            7. Davidovitch RI et al: Challenges in the treatment of femoral neck fractures in the nonelderly adult. J Trauma. 68(1):236-42, 2010
                                            8. Kettunen JA et al: Hip fractures and femoral bone mineral density in male former elite athletes. Bone. 46(2):330-335, 2010
                                            9. Aleem IS et al: Arthroplasty versus internal fixation of femoral neck fractures: a clinical decision analysis. Ortop Traumatol Rehabil. 11(3):233-41, 2009
                                            10. Rehan-Ul-Haq et al: Pipkins type II fracture dislocation of the hip presenting as chondrolysis. J Orthop Sci. 14(4):459-64, 2009
                                            11. Schemitsch E et al: Femoral neck fractures: controversies and evidence. J Orthop Trauma. 23(6):385, 2009
                                            12. Schmidt AH et al: Optimal arthroplasty for femoral neck fractures: is total hip arthroplasty the answer? J Orthop Trauma. 23(6):428-33, 2009
                                            13. Talbot JC et al: Femoral neck stress fractures in military personnel—a case series. J R Army Med Corps. 154(1):47-50, 2008
                                            14. 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
                                            15. Parker MJ et al: Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res. 458:175-9, 2007
                                            16. Dharmarajan TS et al: Hip fracture. Risk factors, preoperative assessment, and postoperative management. Postgrad Med. 119(1):31-8, 2006
                                            17. 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
                                            18. 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
                                            19. Johnell O et al: An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 17(12):1726-33, 2006
                                            20. Lesic A et al: Epidemiology of hip fractures in Belgrade, Serbia Montenegro, 1990-2000. Arch Orthop Trauma Surg. 2006
                                            21. 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
                                            22. Newman JS et al: MRI of the painful hip in athletes. Clin Sports Med. 25(4):613-33, 2006
                                            23. Orwig DL et al: Hip fracture and its consequences: differences between men and women. Orthop Clin North Am. 37(4):611-22, 2006
                                            24. Pihlajamaki HK et al: Displaced femoral neck fatigue fractures in military recruits. J Bone Joint Surg Am. 88(9):1989-97, 2006
                                            25. Sorbie C: Sub-capital hip fracture: best treatment options. J Orthop Surg (Hong Kong). 14(3):237-9, 2006
                                            26. 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
                                            27. Broderick JM et al: Osteoporotic hip fractures: the burden of fixation failure. ScientificWorldJournal. 2013;2013:515197. doi: 10. PubMed Central PMCID: PMC3580900, 1155
                                            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 to neck, & of femoral neck to 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

                                                                                      1. Hak DJ et al: Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics. 38(4):247-51, 2015
                                                                                      2. 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
                                                                                      3. Sheehan SE et al: Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics. 35(5):1563-84, 2015
                                                                                      4. 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
                                                                                      5. 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
                                                                                      6. 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
                                                                                      7. Davidovitch RI et al: Challenges in the treatment of femoral neck fractures in the nonelderly adult. J Trauma. 68(1):236-42, 2010
                                                                                      8. Kettunen JA et al: Hip fractures and femoral bone mineral density in male former elite athletes. Bone. 46(2):330-335, 2010
                                                                                      9. Aleem IS et al: Arthroplasty versus internal fixation of femoral neck fractures: a clinical decision analysis. Ortop Traumatol Rehabil. 11(3):233-41, 2009
                                                                                      10. Rehan-Ul-Haq et al: Pipkins type II fracture dislocation of the hip presenting as chondrolysis. J Orthop Sci. 14(4):459-64, 2009
                                                                                      11. Schemitsch E et al: Femoral neck fractures: controversies and evidence. J Orthop Trauma. 23(6):385, 2009
                                                                                      12. Schmidt AH et al: Optimal arthroplasty for femoral neck fractures: is total hip arthroplasty the answer? J Orthop Trauma. 23(6):428-33, 2009
                                                                                      13. Talbot JC et al: Femoral neck stress fractures in military personnel—a case series. J R Army Med Corps. 154(1):47-50, 2008
                                                                                      14. 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
                                                                                      15. Parker MJ et al: Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res. 458:175-9, 2007
                                                                                      16. Dharmarajan TS et al: Hip fracture. Risk factors, preoperative assessment, and postoperative management. Postgrad Med. 119(1):31-8, 2006
                                                                                      17. 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
                                                                                      18. 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
                                                                                      19. Johnell O et al: An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 17(12):1726-33, 2006
                                                                                      20. Lesic A et al: Epidemiology of hip fractures in Belgrade, Serbia Montenegro, 1990-2000. Arch Orthop Trauma Surg. 2006
                                                                                      21. 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
                                                                                      22. Newman JS et al: MRI of the painful hip in athletes. Clin Sports Med. 25(4):613-33, 2006
                                                                                      23. Orwig DL et al: Hip fracture and its consequences: differences between men and women. Orthop Clin North Am. 37(4):611-22, 2006
                                                                                      24. Pihlajamaki HK et al: Displaced femoral neck fatigue fractures in military recruits. J Bone Joint Surg Am. 88(9):1989-97, 2006
                                                                                      25. Sorbie C: Sub-capital hip fracture: best treatment options. J Orthop Surg (Hong Kong). 14(3):237-9, 2006
                                                                                      26. 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
                                                                                      27. Broderick JM et al: Osteoporotic hip fractures: the burden of fixation failure. ScientificWorldJournal. 2013;2013:515197. doi: 10. PubMed Central PMCID: PMC3580900, 1155