Edited by Mike Gustin and Jeffrey "Spud" Olson - 7/1/2021
Descriptors
Femoral Neck, Subcapital, Transcervical, Basicervical
Garden Classification
- Type I - Incomplete (valgus impacted)
- Type II - Complete, nondisplaced
- Type III - Complete, partially displaced
- Type IV - Complete, fully displaced
Pauwels Classification
- Type I - less than 30 degrees from horizontal
- Type II - 30-50 degrees from horizontal
- Type III - greater than 50 degrees
Intertrochanteric Fractures
- Standard Obliquity
- Reverse Obliquity
- Subtrochanteric Extension
Subtrochanteric Fractures
Atypical Femur Fractures
Exam Pearls
Leg short and externally rotated. Pain with logroll
Workup
Radiographs: AP of the pelvis and hip. Shoot thru lateral.
Full length femur films to assess for distal hardware
Traction view for basicervical vs. intertrochanteric fracture
If atypical, image the contralateral side to assess for beaking for possible prophylactic nail
Other imaging: Typically not needed unless concern for pathologic fracture, or if exam (inability to weight bear) and mechanism is concerning for fracture but XR inconclusive (occult fracture). CT or MRI is suitable in these cases. Concern for abscess or soft tissue pathology.
Labs: Pre-op Labs - T&S/CBC/BMP/Coags/COVID
Other: None
Management
Need for acute intervention: Surgery, ideally within 48 hours
Weight-bearing and range of motion: Non-weight bearing of the affected extremity
Type of immobilization: None
Admission or discharge status: Admit
Anticoagulation: Lovenox x 28 days
Antibiotics: Perioperative Ancef
Surgical Indications
Absolute: These fractures are operative injuries
Standard obliquity ITfx - DHS vs CMN
Subtroch Fx/Reverse Obliquity ITfx/ITFx subtroch extension - CMN
FNFx - Hemi/THA
Subcapital - can consider CRPP for valgus impacted or nondisplaced
Basicervical - can consider DHS/CMN in younger patients