1) Femoral neck fractures are common in the elderly due to osteoporosis and low-energy falls, and have high morbidity and mortality rates, with only 1/3 returning to independent living and 20-35% mortality at 1 year for patients over 80. 2) Femoral neck fractures are typically classified using the Garden or Pauwels classifications, which describe displacement and angle to assess risk of avascular necrosis and nonunion. 3) Treatment options include non-operative management for non-displaced fractures through traction or surgery using internal fixation, hemiarthroplasty, or total hip replacement depending on patient factors and fracture displacement.

1. Femoral neck #
Dr. Ashish P
Asst. Professor
Department of Musculoskeletal Sciences
DVVPF’s College of Physiotherapy,
Ahmednagar

2. Background
• NOF #’s common with advancing age
• High morbidity & mortality
• Only 1/3 return to living environment
• Death: 20-35% at 1 year in patients aged 82 +/-7

3. Anatomy
• Physeal closure age 16
• Neck-shaft angle
130° ± 7°
• Anteversion
10° ± 7°

4. • Blood supply

5. Mechanism of #
• Low-energy trauma; most common in older patients:
– Direct: A fall onto the greater trochanter (valgus
impaction) or forced external rotation of the lower
extremity impinges an osteoporotic neck onto the
posterior lip of the acetabulum (resulting in posterior
comminution).
– Indirect: Muscle forces overwhelm the strength of the
femoral neck

6. • High-energy trauma: This accounts for femoral neck
fractures in both younger and older patients, such as
motor-vehicle accident or fall from a significant height.
• Cyclical loading-stress fractures: These are seen in
athletes, military recruits, ballet dancers; patients with
osteoporosis and osteopenia are at particular risk.

7. Classification of #
• Pauwels [1935]
– Angle describes vertical shear vector

8. • Garden [1961]
I Valgus impacted or
incomplete
II Complete
Non-displaced
III Complete
Partial displacement
IV Complete
Full displacement
** Portends risk of AVN and Nonunion

11. Presentation
• Typically elderly female
• Low energy fall
• Hip pain
• Short & ER leg
• Unable to weight bear

12. Risk factors
• female sex,
• white race,
• increasing age, poor health,
• tobacco and alcohol use,
• previous fracture,
• fall history,
• and low estrogen level.

13. Treatment
• Options
– Non-operative
• very limited role
• Activity modification
• Skeletal traction
– Operative
• ORIF
• Hemiarthroplasty
• Total Hip Replacement

14. Hemiarthroplasty

15. Multiple Screws

16. Dynamic Hip Screw

17. Intramedullary Nail

18. Total Hip Replacement

19. Thank You