Management

Femoral Neck Fracture - Emergency Management

Editors: Scott Sherman MD; Rachel Chin MD

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Background Information

Description

  • A fracture of the proximal femur between the femoral head and trochanters that is due to acute trauma or repetitive stress

Anatomy

  • The femoral neck is bordered by the femoral head proximally and the greater and lesser trochanters distally
  • The normal femoral neck-to-shaft angle is 120-140 degrees(
    1
    )
  • The femoral circumflex arteries surround the base of the femoral neck and provide the predominant blood supply to the femoral head

Etiology

  • Most commonly occurs after minor trauma (for example, ground level fall) in the elderly patient with osteoporosis
  • Rare in young patients, but may be seen when associated with high-energy mechanism trauma or primary bone disease

Epidemiology

  • Most common in elderly White women(
    2
    ,
    3
    ,
    4
    ,
    5
    )
  • Hip fracture incidence is 2 times higher in women than in men(
    3
    )
  • Lifetime risk of hip fracture is 16%-18% in White women and 5%-6% in White men(
    3
    ,
    4
    ,
    5
    )
  • The estimated annual cost in the United States from hip fractures is approximately $15 billion(
    4
    ,
    6
    )
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1Level 1 (likely reliable) Evidence
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There are two types of conclusions which can earn a Level 1 label: levels of evidence for conclusions derived from individual studies and levels of evidence for conclusions regarding a body of evidence.
2Level 2 (mid-level) Evidence
Representing research results addressing clinical outcomes, and using some method of scientific investigation, but not meeting the quality criteria to achieve Level 1 evidence labeling.
3Level 3 (lacking direct) Evidence
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Grades of Recommendation

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