ABSTRACT
There are three sources of blood supply to the femoral head: nutrient artery, artery to the head, and retinacular vessels. Fractures of the femoral neck can be categorised by the Garden classification. This is based on the amount of fracture displacement evident on the anteroposterior X-ray of the hip alone. Fractures can be classified in relation to the capsule of the hip joint – intracapsular or extracapsular. An intracapsular fracture is likely to cause disruption to the blood supply, particularly if displaced. There are two treatment options, femoral head replacement and internal fixation. Femoral head replacement is used in most patients with displaced fractures or pathological fractures. Internal fixation with cancellous screws is used in undisplaced fractures and displaced fractures in patients under 70 years of age. Young patients benefit from preservation of the femoral head, and if the diagnosis is made less than 6 hours after injury an emergency internal fixation can be attempted.
