The fracture line lies in between the subcapital and intertrochanteric lines. Also called femoral head fracture subcapital femoral neck fracture transcervical femoral neck fracture basicervical femoral neck fracture intertrochanteric. Intracapsular femoral neck fractures (Figure 2) can be further classified by their specific location in the neck: subcapital (under the head), transcervical. When hip fracture is detected early, appropriate treatment can minimize morbidity and mortality and prevent the rapid decline in quality of life that often is associated with this injury. Simple and multifragmentary transcervical femoral neck fractures are classified by AO/OTA as 31B2.1 and 31B2.2, respectively. A heightened suspicion for hip fracture should lead to further diagnostic evaluation, especially if the patient has additional risk factors, such as use of a complicated drug regimen, impaired vision, physical or neurologic impairment, or comorbid condition (e.g., osteoporosis, malignancy). Often a bone scan or an MRI is needed to make the diagnosis, as the x-ray might not demonstrate the stress fracture in the first few weeks that a patient has pain. Even when a patient is able to walk and has no documented trauma, localized hip pain, or typical shortening and malrotation deformity, the family physician should be alert to the possibility of hip fracture, particularly in a patient who is older than 65 years, presents with nonspecific leg discomfort, and complains of difficulty bearing weight on the affected limb. Non-displaced fractures, regardless of age of the patient, should be treated with closed reduction and internal fixation. X-rays will often show the injury as a nondisplaced or hairline fracture through the neck of the femur, or at least one side of it. A high index of suspicion often is required for prompt diagnosis and treatment of an occult hip fracture. Intracapsular fractures include: Subcapital: femoral head/neck junction Transcervical: mid. In these patients, additional studies, such as magnetic resonance imaging or bone scanning, may be necessary to confirm the presence of hip fracture. Neck of femur fractures are considered intracapsular fractures. Their ability to walk may be unaffected, and initial radiographic findings may be indeterminate. In some instances, however, patients with hip fracture may complain only of vague pain in their buttocks, knees, thighs, groin, or back. They are often unable to walk, and they may exhibit shortening and external rotation of the affected limb. Patients with hip fracture typically present to the emergency department or their physician's office after a fall.
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