What is the Difference Between Intracapsular and Extracapsular Fracture of Neck of Femur?

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The main difference between intracapsular and extracapsular fractures of the neck of the femur lies in their location with respect to the hip joint capsule.

Intracapsular fractures occur:

  • Proximal to the point at which the hip joint capsule attaches to the femur.
  • These fractures are typically classified into sub-capital, transcervical, and basicervical fractures.

Extracapsular fractures occur:

  • Distal to the point at which the hip joint capsule attaches to the femur.
  • These fractures can be further divided into trochanteric (within the greater and lesser trochanters) and subtrochanteric (proximal to the lesser trochanter) fractures.

Another key difference between the two types of fractures is the risk of avascular necrosis (AVN) and nonunion. Intracapsular fractures, such as femoral head and neck fractures, have an increased rate of nonunion, which can lead to AVN. In contrast, extracapsular fractures, such as intertrochanteric fractures, have a good prognosis following surgery. Subtrochanteric fractures, however, have a high rate of implant failure.

Comparative Table: Intracapsular vs Extracapsular Fracture of Neck of Femur

Intracapsular and extracapsular fractures of the neck of the femur are two different types of hip fractures. Here is a table highlighting the differences between the two:

Feature Intracapsular Fracture Extracapsular Fracture
Location Occurs proximal to the point at which the hip joint is formed Occurs distal to the point at which the hip joint is formed
Anatomical Localization Inside the hip joint capsule Outside the hip joint capsule
Etiopathology Generally associated with osteopenia and osteoporosis in older patients and high-energy trauma in young patients May be associated with lower energy trauma in elderly patients
Treatment Often treated with specific surgeries Treated with internal fixation devices such as dynamic hip screws (DHS) and intramedullary nails (IN)
Complications AVN (Avascular Necrosis) rate depends on the age of the patient; 20% in patients younger than 60 years old, and 12.5% in patients between the ages of 60 and 80 years old May have higher reoperation and complication rates, especially in unstable fractures

Both types of fractures may have similar clinical presentations, such as pain in the groin that radiates down to the thigh, inability to bear weight, etc.. They can be diagnosed through imaging tests and are predominantly treated by specific surgeries.