Neck of femur fractures most commonly occur in elderly patients due to osteoporosis and are often caused by falls. The Garden classification system is used to categorize neck of femur fractures based on the degree of displacement. Treatment depends on factors like the patient's age, bone quality, and fracture displacement - undisplaced fractures may be treated with internal fixation while displaced fractures in elderly patients are typically treated with hemiarthroplasty or total hip replacement.

1. Neck of femur fractures

2. Contents
• INTRODUCTION
• ANATOMY
• MECHANISM OF INJURIES
• CLASSIFICATION
• APPROACH TO NECK OF FEMUR FRACTURES

3. INTRODUCTION
• Neck of femur fractures are more common amongst the elderly patient.
• Risk factors involved in femur fractures are as follow:
1. Osteoporosis
2. Women
3. Low soscioeconomic status
4. Cardiovascular disease
5. medication

4. ANATOMY

5. • PLEASE SEE PAGES 478-486 IN ATLAS OF HUMAN ANATOMY

7. Mechanism of injury
• Falling directly onto the hip
• Twisting mechanism
• Sudden completion if an impartial fracture
• In the young patients it is common after trauma such as MVA and PVA

8. classification
• The Garden classification is used to classify neck of femur fractures
1. Type1: impaction fracture
2. Type 2: non-displaced fracture
3. Type3: varus displacement of the femoral head
4. Type4: complete loss of the continuity amongst fragments

9. • Garden classification system of femoral neck fractures. (A)
Garden I fracture: incomplete and minimally displaced. The
fracture shown is impacted and is in valgus malalignment. (B)
Garden II fracture: complete, nondisplaced. (C) Garden III
fracture: complete fracture and partially displaced. The fracture
shown is in varus malalignment. (D) Garden IV fracture:
completely displaced, with no engagement of the 2 principal
fragments

11. Approach to femur
fractures
• History
• Co-morbidities
• Cause of the fall
• DVT prophylaxis
• Timing of surgery

12. Surgery…..
• ORIF VS ARTHROPLASTY

13. Neck of Femur #
Undisplaced (Garden I-II)
Or
Valgus Impaction
Internal Fixation
Displaced (Garden III-IV)
<65 yr old
Good bone quality
No OA changes
Stable # pattern
Satisfactory, early reduction
Stable fixation
Closed reduction
+
Cannulated screws
>65yr
Poor bonestock
OA of hip joint
Unstable fracture pattern
Reduction unobtainable or
>1/52
Stable fixation not possible
Healthy
Active
Young
Low risk for dislocation
OA/RA Present
THR
Significant comorbid disease
Low demand
Elderly
High risk for dislocation
OA/RA Absent
>5yr life expectancy
Bipolar Hemi-arthroplasty
<5yr life expectancy
Unipolar Hemi-arthroplasty
Non-ambulatory
Non-operable
Relatively painfree
Non-operative management

14. COMPLICATIONS
• INFECTIONS
• THROMBOEMBOLISM
• CHRONIC PAIN
• DISLOCATION
• NON-UNION
• AVASCULAR NECROSIS
• POST TRAUMATIC ARTHRITIC CHANGES

15. RESOURCES
• Atlas of human anatomy(Frank H. Netter)
• Uptodate
• www.google.com
• medscape