An elderly patient after a fall with a shortened, externally rotated leg most likely has which fracture, and what is a possible complication?

An elderly patient after a fall with a shortened, externally rotated leg most likely has which fracture, and what is a possible complication?

• A. Femoral neck fracture; avascular necrosis
• B. Intertrochanteric fracture; malunion
• C. Hip dislocation; sciatic nerve injury
• D. Pubic rami fracture; hemorrhage

Answer: (A)

Shortening with external rotation after a fall in an elderly patient points to a femoral neck fracture, an intracapsular hip fracture. The displacement at the neck plus the pull of surrounding muscles cause the leg to appear shortened and rotated outward. A major complication is avascular necrosis of the femoral head because the fracture disrupts the retinacular vessels supplying the head, compromising blood flow. While intertrochanteric fractures can present similarly, they are extracapsular and AVN is not the typical worry there. Hip dislocation would usually show a different pattern of deformity, and pubic rami fractures tend to cause pelvic instability and hemorrhage rather than isolated AVN of the femoral head.

Shortening with external rotation after a fall in an elderly patient points to a femoral neck fracture, an intracapsular hip fracture. The displacement at the neck plus the pull of surrounding muscles cause the leg to appear shortened and rotated outward. A major complication is avascular necrosis of the femoral head because the fracture disrupts the retinacular vessels supplying the head, compromising blood flow. While intertrochanteric fractures can present similarly, they are extracapsular and AVN is not the typical worry there. Hip dislocation would usually show a different pattern of deformity, and pubic rami fractures tend to cause pelvic instability and hemorrhage rather than isolated AVN of the femoral head.