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Femoral neck fracture
- The most commonly missed hip fracture
We typically think of the presentation of the displaced fracture severe pain, writhing in the bed, unable to ambulate, limited ROM
* However, patients with nondisplaced fractures (15 20%) may walk with a limp
* Occurs primarily in the elderly & osteoporotic population after a fall directly onto the hip
* Look for a cortical step-off in the femoral neck (w/ foreshortening)
* A patient with a minimally displaced fracture may only complain of hip, knee, or groin pain and may be able to walk (albeit with a limp)
* Almost 9% of hip fractures are radiographically normal (Nondisplaced or impacted fractures)
* Fractures which were initially nondisplaced, may become displaced upon re-presentation
* Remember the limitations of plain x-ray in the evaluation of femoral neck fractures!
* Because of the significant complication of overlooking a femoral neck fracture, MRI has become the recommended imaging modality of choice for a patient with a high suspicion for a femoral neck fracture, despite normal plain radiographs of the hip