Femoral neck fracture - About femoral neck fracture

Japanese: 大腿骨頸部骨折 - だいたいこつけいぶこっせつ

$Femoral neck fracture - About femoral neck fracture$

This is a fracture of the femoral neck that is often seen when elderly people fall and are unable to stand or walk. The upper end of the femur has a complex shape, with the greater trochanter protruding significantly upward and rearward, and the lesser trochanter protruding downward and medially, and furthermore, the spherical femoral head protruding from the somewhat slender femoral neck that extends upward and medially. This femoral head forms the hip joint with the acetabulum of the pelvis. Femoral neck fractures are divided into intracapsular fractures (internal fractures) and extracapsular fractures (external fractures) of the hip joint, and the prognosis and treatment methods are completely different.

[Takashi Nagai]

Femoral neck medial fracture

They are divided into subcapital fractures and transverse neck fractures. They are common in the elderly and are known to be difficult to treat. The reasons for this are that they are more likely to occur in the elderly, blood flow is stopped and the femoral head is prone to necrosis, there is no periosteum in the neck, and the fracture line can be oblique. Surgery involves accurate reduction and internal fixation with strong nails, but the method is selected depending on the patient's age and the condition of the fracture. In elderly patients where bone union is difficult, the femoral head is often replaced with an artificial femoral head to avoid prolonged bed rest. Traction therapy is also performed on younger and middle-aged patients.

[Takashi Nagai]

Femoral neck lateral fracture

Although it is slightly more common than internal fractures, the fracture surface is wide, the bone is cancellous and rich in blood vessels, and there is no significant displacement, so even elderly people tend to heal relatively well. Coxa vara is likely to occur. In addition, since it takes a long time for the bone to heal completely, elderly people are prone to complications such as subsidence pneumonia and cystitis, so early ambulation should be considered.

[Takashi Nagai]

[Reference] | Fractures | Artificial joints

Source: Shogakukan Encyclopedia Nipponica About Encyclopedia Nipponica Information | Legend

Japanese:

高齢者が転倒して起立または歩行ができなくなったときに多くみられる大腿骨頸部の骨折である。大腿骨の上端部は複雑な形をしており、後上方に大きく出っ張った大転子と内側下方に出っ張った小転子があり、さらに、内側上方へ伸びたやや細めの大腿骨頸部から突出した球状の大腿骨頭がある。この大腿骨頭は骨盤の寛骨臼(かんこつきゅう)と股(こ)関節をつくっている。大腿骨頸部骨折は、股関節の関節包内骨折（内側骨折）と関節包外骨折（外側骨折）に分けられ、予後および治療法がまったく異なる。

［永井　隆］

大腿骨頸部内側骨折

骨頭下骨折と頸部横断骨折に分けられる。老人に多く、難治性の骨折として知られる。その理由は、高齢者におこりやすいこと、血流が止められ、骨頭が壊死(えし)に陥りやすいこと、頸部には骨膜がないこと、骨折線が斜めにできること、などである。手術によって正確な整復と強固な釘(くぎ)による内固定が行われるが、その方法は患者の年齢と骨折の状態に応じて選択される。高齢者で骨癒合が困難な場合は長期臥床(がしょう)をさけるため人工骨頭に置換することが多い。若年者や壮年者に対しては牽引(けんいん)療法も行われる。

［永井　隆］