What is the diagnosis for a patient with an X-ray of the pelvis showing an acute, mild, displaced and impacted fracture at the base of the right femoral (thigh bone) neck with likely extension into the upper intertrochanteric region, corresponding foreshortening, and varus (angular) deformity?

From the Guidelines

The patient has a displaced and impacted fracture at the base of the right femoral neck with likely extension into the upper intertrochanteric region, corresponding foreshortening, and varus deformity, which requires prompt surgical intervention, typically within 24-48 hours, to reduce morbidity and mortality. The X-ray shows a broken hip, specifically a mildly displaced and impacted fracture at the base of the right femoral neck that likely extends into the intertrochanteric region. This type of fracture requires prompt orthopedic consultation for surgical intervention, as non-operative management is rarely appropriate for displaced hip fractures 1.

Preoperative Management

The patient should be admitted to the hospital, made NPO (nothing by mouth) in preparation for surgery, and started on pain management with IV or oral analgesics such as morphine 2-4mg IV every 4 hours as needed or hydrocodone/acetaminophen 5/325mg 1-2 tablets every 6 hours as needed. DVT prophylaxis with enoxaparin 40mg subcutaneously daily should be initiated. The patient should remain non-weight bearing on the affected side until after surgical repair.

Surgical Intervention

Surgical repair typically involves internal fixation with screws, sliding hip screws, or hip arthroplasty depending on fracture characteristics and patient factors 1. The choice of surgical procedure will depend on the specific characteristics of the fracture and the patient's overall health status.

Postoperative Management

Postoperative management will involve pain management, physical therapy to restore mobility and strength, and monitoring for potential complications such as infection, bleeding, or thromboembolic events. The foreshortening and varus angulation mentioned indicate displacement of the fracture fragments, which further supports the need for surgical management to restore proper alignment and function.

Key Considerations

• Prompt surgical intervention is crucial to reduce complications such as avascular necrosis, non-union, and mortality 1.
• The patient's overall health status and fracture characteristics will guide the choice of surgical procedure.
• Postoperative management will involve a multidisciplinary approach to restore mobility, strength, and function.

From the Research

Diagnosis and Treatment Options

The patient's X-ray shows an acute, mild, displaced and impacted fracture at the base of the right femoral neck with likely extension into the upper intertrochanteric region. Based on the provided evidence, the diagnosis for this patient can be considered as a basicervical femoral neck fracture or an intertrochanteric hip fracture.

Classification and Treatment

• The fracture can be classified as a displaced femoral neck fracture, which may require internal fixation or arthroplasty 2.
• Internal fixation is considered the most satisfactory treatment for an impacted fracture, as it adds certainty to an already stable situation and allows immediate weight-bearing without concern for stability of the fracture 3.
• The use of a screw of the Garden type is preferred for internal fixation, as it secures firm fixation of the fragments without separating the fracture during insertion 3.
• For basicervical femoral neck fractures, hemiarthroplasty may be an underutilized treatment method, with a lower rate of fixation failure or need for reoperation compared to cephalomedullary nail construct 4.
• Open reduction and internal fixation with the Femoral Neck System may be an effective treatment option for irreducible displaced femoral neck fractures, with good functional outcomes and anatomical reduction 5.

Considerations for Treatment

• The treatment option should take into consideration the patient's age, functional demands, and individual risk profile 2.
• For displaced femoral neck fractures in the elderly, cognitive function should be determined, and total hip arthroplasty may be the best option for those who are cognitively functioning 2.
• The use of a dynamic compression hip screw and side plate may be associated with a risk of subcapital femoral neck fracture, and deeper placement of the lag screw may help prevent this complication 6.