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What is a Proximal Femoral Fracture?

A proximal femoral fracture also known as a hip fracture is a condition characterized by a break or fracture in the upper part of the femur or thighbone in close proximity to the hip socket. The hip joint is a weight-bearing, ball-and-socket joint in which the femoral head forms the ball, and the pelvic acetabulum forms the socket. The hip joint surface is covered by smooth articular cartilage that acts as a cushion and enables smooth pain-free movement of the joint. The bones are held together by numerous bands of tissue called ligaments that provide stability to the joint.

Classification of Proximal Femoral Fracture

Proximal femoral fractures are classified into various groups based on the location of the break and include:

  • Femoral Neck Fracture or Trans-cervical fracture: This fracture occurs in the area proximal to the greater and lesser trochanters (bony prominences on the outer and inner aspect of the thighbone)
  • Trochanteric Femur Fracture or Inter-trochanteric fracture: This fracture is present between the lesser and greater trochanter.
  • Femoral Neck or Sub-trochanteric fracture: This fracture develops beneath the trochanters.

Causes of Proximal Femoral Fractures

Proximal femoral fractures are commonly caused due to falls or trauma in people over 65 years old. In children or adults, the injury is mainly caused due to automobile accidents, or any sports injury. Other causes include:

  • Osteoporosis
  • Excess medications
  • Drug abuse
  • Lack of physical fitness

Symptoms of Proximal Femoral Fractures

Some of the common symptoms of a proximal femoral fracture include:

  • Pain in the lower groin area
  • Shortening of the injured leg
  • Tenderness and swelling
  • Stiffness and immobility of the hip

Diagnosis of Proximal Femoral Fractures

Your doctor will review your medical history and symptoms and based on this a physical and neurological examination will be performed. Diagnostic tests can include the following:

  • X-rays: During this study, high electromagnetic energy beams are used to produce images of the broken hip. 
  • Computed Tomography (CT) scan: During this study, special x-rays are used to produce cross-sectional images of the damaged hip.
  • Magnetic Resonance Imaging (MRI) Scan: This is an imaging study that uses a large magnetic field and radio waves to detect any damage to soft tissues and bones.
  • Bone scan: This is a nuclear imaging study that helps detect hidden stress fractures or any bone disorders.

Treatment for Proximal Femoral Fracture

Treatment for a proximal femoral fracture includes:

Conservative Methods: Non-displaced fractures may sometimes be treated by: 

  • Medications: Your doctor will prescribe over-the-counter pain medications to reduce inflammation and pain.
  • Physical therapy: Your doctor will recommend special exercises to strengthen the bones and muscles.
  • Skin Traction: In this method, a splint is applied to the skin, and force is applied to gently pull on the injured area for a better approximation of the fractured ends of the bone. 
  • Skeletal Traction: In skeletal traction, a pin will be inserted through the bone and attached to a rope. Weights are applied, and you will be placed in a traction apparatus to guide the fractured bones to their correct position. 

If non-surgical methods fail to improve the symptoms, surgery will be recommended based on the severity of the fracture. Surgical treatments can include:

  • Open Reduction and Internal Fixation (ORIF): In this technique, the fracture site is exposed and internal fixation is performed with wires, screws, and nails that are attached to a metal plate placed inside the body.
  • Hemiarthroplasty: A part of the hip joint is substituted by a metal prosthesis.
  • Total Hip Replacement (arthroplasty): Your doctor will remove the damaged hip joint surfaces and replace them with artificial implants made of plastic or metal. 
  • American Academy of Orthopaedic Surgeons
  • American Orthpaedic Society for Sports Medicine