The document outlines the causes, risk factors, clinical features, diagnostics, and treatment options for proximal femoral fractures, which primarily include femoral neck, intertrochanteric, and subtrochanteric fractures. It discusses the mechanics of injury, the classification of fractures, and various surgical and non-surgical options based on patient age and fracture type. It also highlights the importance of considerations such as osteoporosis, muscle weakness, and prior medical conditions in the assessment and management of these fractures.

1. PROXIMAL
FEMORAL
FRACTURES
SHIFA MOHAMED RAFI

2. ANATOMY OF FEMUR

3. ANATOMY OF HIP JOINT

4. Proximal Femoral Fractures
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5. CAUSES AND RISK
FACTORS
Mechanism of injury
• Fall onto greater trochanter/lateral hip
• Forced lateral rotation (e.g., from tripping)
• Chronic overburdening can lead to
insufficiency fracture which can then
completely fracture spontaneously
• Pathological fracture due to metastases
• motor vehicle accidents or falls from great
heights or underlying disease (e.g., fibrous
dysplasia)
• Risk factors
⚬ Osteoporosis(especially postmen
opausal women and older
individuals)
⚬ Muscle weakness
⚬ Difficulty walking and impaired
coordination
⚬ Estrogen deficiency
⚬ Low body weight
⚬ Poor nutrition (vitamin D
deficiency or calcium deficiency)
⚬ Smoking, alcohol use

6. INTRACPSULAR AND
EXTRACAPSULAR
The terms hip fracture and femoral neck fracture
both relate to the same type of injury. Both terms
describe a fracture of the proximal femur
between the femoral head and 5 cm distal to the
lesser trochanter. A hip fracture occurs just below
the head of femur (HOF), the region of the femur
called the femoral neck. A femoral neck fracture
disconnects the HOF from the rest of the femur.
Femoral neck fracture both relate to the same
type of injury. Both terms describe a fracture of
the proximal femur between the femoral head and
5 cm distal to the lesser trochanter

7. PATHOLOGY
⚬ division into intracapsular and
extracapsular fractures
⚬ intracapsular
￭ femoral head: fractures of the
head that extend to the joint
￭ femoral neck: extra-articular,
intra-capsular fractures
⚬ extracapsular
￭ trochanteric: fractures that
span the intertrochanteric
line
￭ subtrochanteric: fractures
below the trochanters

8. FEMORAL HEAD FRACTURE
•Occurrence: uncommon but often associated with a posterior hip dislocation following a
dashboard injury
•Clinical features
⚬ Groin pain
⚬ Local swelling and ecchymosis
•Diagnostics
⚬ Hip x-ray (AP with internal rotation and lateral view; should include the proximal thigh) MRI
if findings are unclear or if an occult fracture is suspected
• Surgical
⚬ Children and young adults:
open reduction internal fixation with maintenance of the femoral head
⚬ Older adults or those with predispositions or instabilities: total hip replacement

9. FEMORAL NECK
FRACTURE
•Clinical features
⚬ Groin pain
⚬ Shortened and externally rotated leg
⚬ Minimal bruising
•Diagnostics
⚬ X-ray
⚬ MRI or bone scan if clinical suspicion is high despite absent findings on x-ray
Treatment
⚬ Temporary bed rest; or use of crutches followed by mobilization with physical
therapy
⚬ Venous thromboembolism prophylaxis
⚬ Surgery (usually within 72 hours
⚬ For children and young adults:
⚬ Early open reduction internal fixation (ORIF) (within 6 hours)
⚬ For older adults: total hip replacement (THR) or hip hemiarthroplasty

11. TROCHANTERIC
FRACTURES
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Per trochanteric femoral fracture

12. INTERTROCHANTERIC
FRACTURE
•Clinical features
⚬ Hip pain and swelling
⚬ Shortened and externally rotated leg
⚬ Significant ecchymosis
⚬ Often associated with other injuries (e.g., other
extremity fractures)
•Diagnostics
⚬ X-ray
⚬ MRI
•Treatment
⚬ Nonsurgical approach for high-risk patients
⚬ Surgery
￭ Dynamic hip screw (DHS) for stable
fractures
￭ Intramedullary nail (Gamma nail) for stable
or unstable fractures, fractures extending
into the subtrochanteric region, or reverse
oblique fractures
￭ Arthroplasty may be considered
for comminuted fractures

14. SUBTROCHANTERIC
FRACTURE
•Clinical features
⚬ Hip pain with swelling
⚬ Shortened and externally rotated leg
⚬ Significant ecchymosis
•Diagnostics
⚬ X- Ray
⚬ MRI
•Treatment
⚬ Consider conservative approach (e.g., traction)
in surgically unstable patients
⚬ Surgery is indicated in
displaced/nondisplaced fractures in adults,
especially if associated with multiple trauma,
an open fracture, or pathological fractures
￭ Long intramedullary nail with a lag screw
￭ Locking plate may be considered for
complicated fractures (e.g., pre-
existing femoral deformity,
associated femoral neck fracture)
Subtrochanteric fracture of the left femur, type C

15. REFERENCES
• http://www.orthobullets.com/trauma/1037/femoral-neck-
fractures
• https://radiopaedia.org/articles/proximal-femoral-fractures-
summary
• https://www.amboss.com/us/knowledge/Hip_fractures/
• https://www.orthobullets.com/trauma/1037/femoral-neck-
fractures
• https://radiology.expert/x-hip/pathology/proximal-
femoralfractures/
• https://radiopaedia.org/articles/proximal-femoral-fractures