Presentation
Fall one month ago, with persistent and worsening limp, severe pain in left hip.
Patient Data
Subcapital transverse fracture of neck of left femur with mild cranial migration of femoral shaft. Moderate joint effusion with articular loose bodies. Serpiginous alterenating T2 hyper and hypointense signals seen in medulla on both sides of the fracture margin likely medullary infarction. Extensive marrow edema in proximal femur diaphysis and in surrounding muscles.
CT correlation was done to document the fracture and for a clearer depiction of the fracture line.
Case Discussion
The femoral neck is a common site of fracture as our bones become less dense with age. Surgical management depends on the site of fracture: intracapsular fractures such as in this case are more likely to have a disrupted blood supply and hence go on to develop avascular necrosis. For displaced intracapsular fractures, hip replacement (either hemiarthroplasty or total hip replacement) is generally preferred. The exception to this is in the younger patient where it may be preferable to try and preserve the native hip joint by initial fixation, with replacement later if avascular necrosis develops.
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