Femoral Neck Fracture

00:01 Let's move on to a potential traumatic femoral neck fracture.

00:06 Long bone fractures can be deadly, particularly in elderly patients.

00:12 Generally speaking, femoral neck fractures occur when the patient falls on the lateral hip.

00:19 There's also usually assisted – associated twisted mechanism where the foot is stuck, but the body is actually twisting.

00:28 On physical examination, there may be obvious deformities, such as external rotation or a shortened extremity.

00:36 Remember, don't over-manipulate these on physical examination.

00:40 Sometimes, when the external injury is not obvious, patients often complain of groin pain, especially on weight-bearing.

00:49 And remember, particularly in traumatic situations, this may be open.

00:54 In other words, the skin overlying the fracture is actually lacerated.

01:00 These require urgent debridement because the joint can become infected.

01:07 Here's an image.

01:08 It’s quite classic of a proximal femoral neck fracture.

01:12 You notice – you notice that the acetabulum in the femoral head is intact.

01:16 However, the proximal femur is now fractured.

01:23 These generally require surgery.

01:26 It usually requires ORIF (open reduction internal fixation).

01:33 If your patient is extremely elderly, bedridden or very debilitated, remember, an open reduction and internal fixation of any major joint is a very, very complex procedure and associated oftentimes with significant blood loss.

01:49 If your patient is already bedbound or severely debilitated, there's always the option of non-operative management.

01:57 Here are some post-reduction films.

01:59 Clearly, you notice after the ORIF, the alignment looks great.

02:05 Very important concept.

02:06 Hope you're paying attention.

02:08 Fat embolism is associated with long bone fractures.

02:12 In fact, on a clinical scenario, when you're presented with a posttraumatic patient, with this constellation of symptoms, think fat embolism.

02:22 Let's review.

02:23 They include neurological abnormalities, altered mental status, for example, a classic petechial rash all over the body and variable hypoxia.

02:36 In fact, oftentimes, fat embolism patients are suspected of having a pulmonary embolism.

02:44 The etiology of fat embolism is not completely understood.

02:49 There's maybe introduction of fat globules into the systemic circulation when the bone is actually fractured.

02:57 Additionally, we think that there is an inflammatory process that leads to free fatty acids.

03:02 The jury is still out.

03:07 The management of fat embolism is high index of suspicion and mostly supportive.

03:12 We want to treat the hypoxia and the patient may require ventilator assistance if hypoxia is profound or worsening.