The neck shift angle is approximately 130 degrees.
Anteversion is approximately 10 degrees. The calcar is an area of stress
transfer. It is a posteromedial dense plate of bone. It forms an internal strut
within the inferior part of the femoral neck and the intertrochanteric area. No
periosteum in the femoral neck and no abundant callus. The fracture heals by
endosteal proliferation. The medial femoral circumflex artery is the most
important blood supply to the femoral head. In young patients, injury is usually
high energy that may lead to avascular necrosis. Some believe that surgery
should be urgent in the young patient in order to decompress the compressed
vessels. The more displaced the fracture and the more vertical the fracture,
then the more likely that the risk of complications will occur including
disruption of the retinacular vessels, avascular necrosis, and nonunion.
Femoral neck reduction should be anatomic, either by closed technique or open
technique (if closed reduction technique fails).
