General/Introduction
The femoral neck fracture (Syn. femoral neck fracture), describes a fracture of the femur near the hip joint. Usually, a fall on the side is the reason for a fracture of the neck of the femur. Due to the increased tendency to fall and slower reflexes, it is a common injury for older people.
Epidemiology
Femoral neck fracture is a very common injury pattern, especially in the elderly. This is due to reduced mobility, reduced reflexes and a significantly increased tendency to fall. Due to the high risk factor osteoporosis, women are affected significantly more often than men.
Cause
The reason for the fracture of the neck of the femur is a fall on the hip, while the leg is angled (abduction position) or strongly angled (adduction position) in the hip. The femoral neck fracture is classified according to anatomical features on the one hand and the causal injury mechanism on the other. Anatomically, a distinction is made between: Since the blood vessels supplying the femoral head run towards the middle, a fracture of the middle femoral neck increases the risk of a reduced supply to the femoral head and its loss of function.
According to the injury mechanism, the femoral neck fracture is classified according to Pauwels and Garden. The Pauwels classification refers to the fracture during abduction (abduction fracture) of the leg. The following O- leg malposition (varus malposition) or X- leg malposition (valgus malposition) is also part of the pauwel’s classification.
The angle refers to the horizontal between the greater trochanter and the center of rotation of the femoral head, as well as the fracture line. Garden refers to the femoral neck fracture in relation to the displacement of the individual fragments: Since the two classifications complement each other, each femoral neck fracture is classified according to Pauwels and Garden in terms of its severity, thus determining the subsequent therapy and prognosis.
- Lateral fractures (lateral)
- And the fracture gap lying towards the center (medial).
- Pauwels I means a break line to the horizontal up to 30°.
Since the angle is small, there is still a good stability despite the break.
- Pauwels II denotes a break line to the horizontal between 30 and 50°.
- Pauwels III describes the break line over 50°. Due to the shear forces, this large fracture angle causes a displacement (dislocation) of the two fractions.
- Garden 1 denotes an incomplete break without shifting of the fractions.
- Garden 2 describes a complete break without displacement
- Garden 3 a complete break with partial displacement of the break ends.
- Garden 4 is the most severe form of femoral neck fracture. Here the fractions are completely displaced and the fracture surfaces no longer have contact with each other.
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