What is it: A fracture through the femoral neck or intertrochanteric region of the femur. Typically the result of a fall and are common in elderly individuals with osteoporosis.
How does it present: Most often patients present after a fall with complaints of groin or buttock pain and difficulty with weight bearing.
Common exam findings: Inspect for deformity, swelling and open injuries. A thorough musculoskeletal examination may avoid overlooking other associated injuries. A neurovascular exam should be documented. Patients may prefer to have the limb in an externally rotated and abducted position and it may appear shorter that the other side. Patients are usually unable to perform a straight-leg raise. Pain with the Femoral Log Roll Test and Heel Strike Test may help identify possible femur fractures. Pain on the Fulcrum Test evaluates for non-displaced fractures, including femoral stress fractures.
Tests and treatment: Anteroposterior (AP) view of the pelvis along with AP and lateral radiographs of the femur will diagnose most proximal femur fractures. If radiographs are normal or equivocal but a high index of suspicion exists for a proximal femur fracture, MRI is warranted. Surgical treatment is indicated for the vast majority of patients unless medically unstable or non-ambulatory. Skeletal traction or a pillow placed behind the knee may be useful aids for patients awaiting surgical evaluation. Delay of more than 48 hours from the time of injury to surgical intervention is associated with increased morbidity and mortality. The type of fracture dictates the recommended surgical procedure. Bone densitometry should be considered following surgical correction if a diagnosis of osteoporosis is not already known.