Anteroposterior radiograph of a 90-year-old woman’s left hip after a fall
Lateral radiograph of the patient’s left hip
Editor’s Note: This article was updated on May 25, 2016, to correctly list the patient’s affected hip as the left hip.
A 90-year-old woman is brought to the emergency department by emergency medical services after sustaining a fall at home. She woke up in the middle of the night to use the bathroom, lost her balance, and fell on her left hip. She was unable to get up from the floor because of severe pain in the hip. On examination, the left lower extremity is shortened and rotated externally. Anteroposterior and lateral radiographs are taken.
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The patient sustained a displaced femoral neck fracture, which was evident on the radiographs. Femoral neck fracture is one of the most common fractures in the elderly population. The injury can cause significant disability and death, with a same-year mortality rate of 25%. Displaced femoral neck fractures disrupt the hip capsule and blood supply to the femoral head.
Treating the fracture with closed reduction and cannulated screw fixation would not restore blood supply to the femoral head, and osteonecrosis would occur. Therefore, the treatment of choice for displaced femoral neck fracture in this age group is head replacement or hemiarthroplasty.
Total hip arthroplasty is generally reserved for younger more active patients and for those with preexisting arthritis who sustain a displaced femoral neck fracture. Total hip arthroplasty offers better pain relief and functional outcome in this population than hemiarthroplasty. Cannulated hip screw fixation is recommended for nondisplaced femoral neck fractures, as the hip capsule and femoral head blood supply remain intact and healing is likely. Intramedullary nail fixation is indicated for intertrochanteric hip fractures.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- Blomberg J. Femoral neck fractures. http://www.orthobullets.com/trauma/1037/femoral-neck-fractures. Updated May 1, 2016. Accessed May 23, 2016.
- Koval KJ, Zuckerman JD. Femoral neck fractures. In: Koval KJ, Zuckerman JD. Handbook of Fractures. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:318-328.