FRACTURE OF NECK OF FEMUR

FRACTURE OF NECK OF FEMUR

1. Definition: The fracture of the femoral neck is a break in the neck of the femur bone.

2. Types:

   1. Intertrochanteric fracture: Occurs between the greater and lesser trochanters of the femur.
   2. Subtrochanteric fracture: Occurs below the lesser trochanter.
   3. Basicervical fracture: Occurs at the base of the femoral neck.
   4. Transcervical fracture: Occurs through the neck of the femur.
   5. Cervicofemoral fracture: Occurs through the junction of the femoral neck and shaft.

3. Pathology:

   1. The most common cause of femoral neck fracture is osteoporosis.
   2. Other causes include hip fractures due to osteopenia, hip dislocation, and direct trauma.
   3. Fractures can be classified as stable or unstable based on the displacement of the fracture fragments.
   4. The blood supply to the femoral head is compromised in femoral neck fractures, which can lead to avascular necrosis of the femoral head.
   5. The risk of avascular necrosis increases with the delay in surgery.

4. Causes:

   1. Osteoporosis is the most common cause of femoral neck fractures.
   2. Trauma from falls or direct blows to the hip.
   3. Hip fractures due to osteopenia.
   4. Hip dislocation.

5. Clinical Features:

   1. Acute onset of pain in the hip or groin area.
   2. Limited range of motion in the hip joint.
   3. Difficulty walking or bearing weight on the affected leg.
   4. Swelling and bruising in the affected area.
   5. Shortening of the affected leg.

6. Investigations:

   1. X-rays of the hip joint to confirm the fracture.
   2. CT scans to assess the extent of the fracture and the blood supply to the femoral head.
   3. MRI scans to assess the blood supply to the femoral head and the presence of avascular necrosis.
   4. Blood tests to assess for osteoporosis and other underlying conditions.

7. Complications:

   1. Avascular necrosis of the femoral head.
   2. Nonunion or delayed union of the fracture.
   3. Malunion of the fracture.
   4. Infection.
   5. Deep vein thrombosis.

Fracture of Neck of Femur

Anatomy and Blood Supply

• Anatomy: The femoral neck is the narrow part of the femur (thigh bone) between the head and the greater trochanter.
• Blood supply: The blood supply to the femoral neck is primarily from the medial and lateral circumflex femoral arteries, with some contribution from the inferior gluteal artery.

Mechanisms

• Mechanisms of injury: Fractures of the femoral neck can occur due to:
  • Low-impact trauma (e.g., falls from a standing height)
  • High-impact trauma (e.g., motor vehicle accidents)
  • Sports injuries
  • Osteoporotic fractures
• Pathological fractures: Fractures of the femoral neck can also occur due to underlying pathological conditions, such as:
  • Osteoporosis
  • Osteonecrosis
  • Metastatic bone disease

Clinical Features

• Clinical features of a femoral neck fracture include:
  • Pain in the hip or groin area
  • Limited mobility or inability to bear weight
  • Swelling or bruising in the affected area
  • Abnormal gait or limping
• Pathological fractures may also present with:
  • Systemic symptoms, such as fever or weight loss
  • Localized pain or tenderness
  • Limited mobility or functional impairment

Investigations

• Imaging studies: Fractures of the femoral neck are typically diagnosed using imaging studies, such as:
  • Plain radiographs (X-rays)
  • Computed tomography (CT) scans
  • Magnetic resonance imaging (MRI) scans
• Other investigations: In some cases, additional investigations may be necessary, such as:
  • Blood tests (e.g., complete blood count, liver function tests)
  • Bone scans

Complications

• Complications of femoral neck fractures include:
  • Nonunion or delayed union
  • Malunion or malalignment
  • Osteonecrosis
  • Infection
  • Neurovascular injury
• Pathological fractures may also be associated with:
  • Systemic complications, such as sepsis or multi-organ failure
  • Localized complications, such as abscess or osteomyelitis

Management

• Management of femoral neck fractures depends on the type and severity of the fracture, as well as the patient's overall health and functional status.
• Treatment options include:
  • Closed reduction and internal fixation (CRIF)
  • Open reduction and internal fixation (ORIF)
  • Hemiarthroplasty
  • Total hip arthroplasty
• Pathological fractures may require:
  • Biopsy to confirm the underlying diagnosis
  • Chemotherapy or radiation therapy to treat the underlying condition
  • Supportive care, such as pain management and physical therapy

Treatment

• Treatment of femoral neck fractures involves a combination of:
  • Immobilization or stabilization of the affected limb
  • Pain management
  • Rehabilitation and physical therapy
  • Follow-up care to monitor for complications or progression of the underlying condition
• Pathological fractures may also require:
  • Chemotherapy or radiation therapy to treat the underlying condition
  • Supportive care, such as pain management and physical therapy

Homoeopathic Therapeutic Approach

• Indications for homoeopathic treatment of femoral neck fractures include:
  • Acute pain or discomfort
  • Limited mobility or functional impairment
  • Systemic symptoms, such as fever or weight loss
• Homoeopathic medicines that may be indicated for femoral neck fractures include:
  • Arnica montana for pain and swelling
  • Bellis perennis for bruising and trauma
  • Causticum for numbness or tingling
  • Rhus toxicodendron for stiffness and limited mobility
  • Hypericum for nerve damage or neurovascular injury
• Homoeopathic treatment should be individualized and based on the patient's specific symptoms and needs.

Homoeopathic Medicines

• Arnica montana: For pain and swelling, use 5-10 drops of 30C potency, 3-4 times a day.
• Bellis perennis: For bruising and trauma, use 5-10 drops of 30C potency, 3-4 times a day.
• Causticum: For numbness or tingling, use 5-10 drops of 30C potency, 3-4 times a day.
• Rhus toxicodendron: For stiffness and limited mobility, use 5-10 drops of 30C potency, 3-4 times a day.
• Hypericum: For nerve damage or neurovascular injury, use 5-10 drops of 30C potency, 3-4 times a day.