![]() ![]() In the setting of femoral neck fractures, nonoperative management is rarely indicated, given the devastatingly highly-associated complication rates. Īchieve restoration of alignment and osseous healing (following surgical fixation techniques) AVN of the femoral head is very rare following extracapsular fractures. In contrast, extracapsular fractures rarely compromise the arterial blood supply to the femoral head and neck and, thus, are commonly managed with various types of surgical fixation techniques. Nondisplaced fractures can be managed with fixation using cannulated screw fixation. These procedures typically include hip hemiarthroplasty or total hip arthroplasty (THA) procedures. The femoral head and neck are replaced with a reconstruction prosthesis. ĭisplaced intracapsular femoral neck fractures in the elderly are typically managed with hip reconstruction procedures. ![]() In addition to the tamponade effect mentioned above and its potential compromise to femoral head blood flow, patients with femoral neck fractures risk developing avascular necrosis (AVN) due to the retrograde blood supply and injury to the retinacular vessels. Minimal supply from the medullary canal and inferior gluteal artery The arterial blood supply to the femoral head arises from three main sources. A tamponade effect that compromises femoral head perfusion has been demonstrated in previous studies. There is a theoretical risk of compromised blood supply to the femoral head secondary to increased intra-articular pressures in the setting of an intracapsular FNF with preservation of the hip joint capsule. The hip joint capsule attaches to the intertrochanteric line anteriorly and the crest posteriorly. The distinction between these fracture patterns is critical because intracapsular fractures demonstrate limited healing potential secondary to the absence of the periosteal layer, and the fracture is bathed in the surrounding synovial fluid. įemoral neck fractures are differentiated from extracapsular hip fracture patterns based on anatomic location. The majority of these fractures occur in elderly patients with underlying osteoporosis. Intracapsular femoral neck fractures account for approximately 50% of all hip fractures. ![]()
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