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Abstract
Femoral neck fractures in elderly patients are complicated injuries that require medical, social, and surgical treatment and consume considerable healthcare resources.
The hip joint is a ball and socket joint composed of the acetabulum and femoral head.
The stable hip joint is constructed to allow for a large range of motion necessary for normal daily activities such as walking, sitting, and squatting.
Such a joint must be precisely aligned and controlled.
Two forces acting on the hip joint, the first is the body weight which can be depicted as a load applied to a lever arm extending from the body’s center of gravity (in the midline anterior to the second sacral vertebral body) to the center of the femoral head.
The second is the abductor musculature, acting on a lever arm extending from the lateral aspect of the greater trochanter to the center of the femoral head.
The two forces must exert an equal moment to hold the pelvis level when in a onelegged stance, and a greater moment to tilt the pelvis to the same side when walking or running. Femoral neck Fractures occur predominantly as low-energy trauma in the elderly.
Approximately 90% of neck fractures in this population result from a simple fall.
The high prevalence of these injuries in the elderly is related to numerous factors, including osteoporosis, sedentary lifestyle, and associated medical comorbidities.
The current overall 1-year mortality after hip fractures in the elderly population ranges from 12% to 36%, which is in excess to age-matched controls.
Two mechanisms of injury in femoral neck fractures, the first is a fall producing a direct blow over the greater trochanter.
The second mechanism is lateral rotation of the extremity, in this mechanism; the head is firmly fixed by the anterior capsule and iliofemoral ligaments while the neck rotates posteriorly.
The posterior cortex impinges on the acetabulum and the neck buckles.
This mechanism is compatible with the marked posterior comminution of the neck.
Forces within physiologic limits have been shown to produce fractures in osteoporotic bone.