Femoral Neck Fracture Classification - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes classifications of femoral neck fractures.

Femoral neck fractures can occur as a result of low energy trauma in the elderly. In this case you will need to get a medical consultation! Femoral neck fractures can also occur due to high energy trauma, such as with falls or motor vehicle accidents. Femoral neck fractures can occur in older as well as younger patients, and in these cases you need to apply the ATLS protocol. Femoral neck fractures can also occur due to insufficiency fractures. This occurs due to weak bones, because of osteoporosis or osteopenia. The patient will have groin pain, pain with axial compression and the x-ray may be normal (helpful in diagnosing insufficiency fracture). There may also be a stress fracture due to overuse and more loading on the hips. Stress fractures may occur in athletes, ballet dancers, or military recruits.
Anatomic classification
1. Subcapital – common
2. Transcervical
3. Basicervical
The subcapital fracture has two classifications: the garden classification and Pauwel’s classification. The garden classification system classifies the fracture according to the amount or degree of displacement. It relates the amount of displacement to the risk of vascular disruption. This classification applies to the geriatric and insufficiency fractures. It can then be classified into two groups: the nondisplaced and the displaced. Types I and II are nondisplaced, while types III and IV are displaced. Type I is incomplete and impacted in valgus. Type II is a complete fracture and nondisplaced on at least two planes (anteroposterior & lateral). Type III is a complete fracture and partially displaced. The trabecular pattern of the femoral head does not line up with the acetabular trabecular pattern. A type IV fracture is completely displaced with no continuity between the proximal and distal fragments. The trabecular pattern of the femoral head remains parallel with the acetabulum trabecular pattern.
The Pauwel’s Classification is classified into three fracture types. It classifies the fracture according to the orientation and direction of the fracture line across the femoral line. It related to the biomechanical stability. The more vertical the fracture, the more sheer forces and the more the complication rate. Type I is stable and has an obliquity ranging from 0-30 degrees. Type II is less stable and have an obliquity ranging from 30-50 degrees. Lastly, type III is unstable and has an obliquity between 50-70 degrees or more. As the fracture progresses from Type I – Type III, the obliquity of the fracture line increases. As the fracture line becomes more vertical, the sheer forces increase and the instability increases. A horizontal fracture is good and stable while a vertical fracture is bad and unstable. The more displaced the fracture, the more disruption of the blood supply and the chance of avascular necrosis and nonunion (can occur in about 25% of displaced fractures). In nonunion occurs in a younger patient, you may help the patient by doing a subtrochanteric osteotomy to reorient the fracture line from vertical to horizontal (will help the fracture healing).
Femoral Neck Fractures Associated with Femoral Shaft Fractures
The typical neck fracture is vertical and nondisplaced. It may require internal rotation view x-rays to see this hip fracture (fracture could be missed). Treatment of this fracture is to fix the femoral neck fracture first, followed by the femoral shaft fracture. The usual combination is parallel screws in the femoral neck and a retrograde femoral rod for the fractured femur.
Stress fractures are more common in females due to the female athletic triad. It can be a tension fracture. The fracture or callus is present on the superior aspect of the femoral neck. Adult bone is weak in tension, so stress fracture of the femoral neck needs to be fixed! This should be an emergency operation before the fracture displaces. With compression fractures, the compression or callus is present on the inferior aspect of the femoral neck. It is believed that if the compression fracture is less than 50% across the neck, then the fracture could be stable and you can do protected crutch ambulation. If the fracture is more than 50% across the neck, then the fracture is unstable and you will do an ORIF. Some surgeons fix all stress fractures of the femoral neck. A female runner with groin pain can indicated a stress fracture. Get an MRI, the fracture will probably need to be fixed.

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[manmahuna]

I'm so Grateful professor, your lectures are so helpful.
Well summarized

[HCarota]

Thank you Professor for another great educational video. Your work is very appreciated. Greetings from Switzerland

[liubapetcu]

Mii de mulțumiri pentru minunatele informații!

[dr.asheralbert]

Thank u sir! U r the king of orthopedics 🙏🏼💯❤

[waltersreflection]

Thx for this I had one of these happen to me while skating I finally recovered. It took me 5 whole months to recover and I was in a wheelchair for a while which messed with my school life especially since I was in 7th I'm going to 8th in August

[lifeasiknewit.lifeofamedic]

Wow, thank you so much. This lecture is very clear and helpful!

[janmohammadkhalid]

That was interesting sir. Thank you so much.

[tristenmaguire]

I’m 25 and just had 2 hip surgeries for my femoral neck. I didn’t even do anything, I’m literally walking from kitchen to my living room getting my wife some water, I feel a pop and a tear and I’m on the ground in the most pain I’ve ever felt. According to the X-Ray my break was type 4. Completely displaced

[guozhengzhu]

great presentation! great explanation!

[dramrawad]

Thanks dear professor for the clear amazing video

[shine]

What is the imaging protocol for femoral neck fractures

[Reneebenson]

As far as I know I haven’t broke anything the dr saw bone spurs and some hip impinchment

[sharonalimmagno]

What's o r I f is it safe as kurchner wires

[ulfeliasson]

Can you swim breast stroke if you have a femoral neck fracture? I figure the kick might be bad?

[punitsolanki]

dear sir,
i am suffering from fracture in neck of fumer. i am 37 years old healthy man. after one & half months totally bed rest my doctor suggested me for walk inside the home with help of walker and adviced for next month check up.
doctor said it is nice recovery but i am so affraid and want to know something about my problem.
if you see my msg than please provide me solution for my queries.
thanks.

[pedrolim]

Why not mention the basecervical neck femur. Dynamic hip screw also not mention.