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()
  • 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(,,,)
  • Hip fracture incidence is 2 times higher in women than in men()
  • Lifetime risk of hip fracture is 16%-18% in White women and 5%-6% in White men(,,)
  • The estimated annual cost in the United States from hip fractures is approximately $15 billion(,)
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DynaMed provides easy-to-interpret Level of Evidence labels so users can quickly find and determine the quality of the best available evidence. Evidence may be labeled in one of three levels:

1Level 1 (likely reliable) Evidence
Representing research results addressing clinical outcomes and meeting an extensive set of quality criteria which minimizes bias.
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
Representing reports that are not based on scientific analysis of clinical outcomes. Examples include case series, case reports, expert opinion, and conclusions extrapolated indirectly from scientific studies.

Grades of Recommendation

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