![]() ![]() Finally, in displaced fractures, a traction internal rotation AP view of the proximal femur can be quite helpful in establishing the fracture pattern and help determine treatment. One can also place a calibration bearing during the AP pelvis to help with preoperative planning for possible hemiarthroplasty or total hip arthroplasty. Internal rotation of the hips will help to display the femoral necks and allow comparison of the bony contours, which will help identify subtle and impacted fractures. It may be useful to obtain a “low” AP pelvis to show more of the proximal femur, which can be helpful in surgical planning. The standard radiographs to screen for a femoral neck fracture are an AP pelvis and frog leg lateral of the hip. ![]() Gentle attempts at internal or external rotation will illicit immediate pain. The patient will typically present with anterior groin pain and an inability to walk, usually with a shortened and externally rotated leg. These fractures generally occur from low-energy mechanisms, such as falls from a standing height, in patients with osteopenia or osteoporosis. Non-operative care is reserved for bedridden patients who are insensate or neurologically impaired, or those with severely limited life expectancy. In general, most patients with femoral neck fractures benefit from surgical intervention, at least for pain control, even older sedentary patients. The timing or urgency for surgical intervention may also depend on which type of fracture has occurred. The indications for surgery and the surgical management differ depending on the type of patient and the type of fracture. Two different patient populations typically sustain femoral neck fractures: older patients who are usually injured in low-energy falls from standing height and younger patients who generally suffer from high-energy mechanisms. ![]()
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