What Is a Proximal Femoral Fracture?

The femur is the thigh bone, which runs from the hip joint to the knee joint. A femur fracture, or femoral fracture, can be proximal or distal. Distal describes a point farther away from the center of the body, so moving toward the end of a limb, while proximal refers to something which is nearer to the torso. The proximal femur is the end closest to the hip bone, and it includes the rounded femoral head, which is part of the hip joint, and the femoral neck, on which the head sits. A proximal femoral fracture is more commonly known as a hip fracture, or broken hip, and it most often occurs in female, elderly patients after a simple fall.

In the elderly, fractures of the proximal femur are typically associated with a condition called osteoporosis. Osteoporosis makes bones weaker and more likely to break, and a broken hip is one of the most common complications. Proximal femoral fracture also occurs occasionally in younger people, when it is more likely to be caused by an extreme injury such as a motor vehicle accident. Fractures are more likely to occur in people who have had one before or whose mothers have had one. Other factors which increase the risk of proximal femur fracture include smoking, lack of exercise, low body weight and dementia.

There are different types of proximal femoral fracture, and they can be classed as intracapsular or extracapsular. Intracapsular fractures occur inside the capsule that encloses the hip joint, while extracapsular breaks take place in areas of bone that lie outside the capsule. Sometimes the pieces of bone are moved out of alignment, which can increase the risk of complications.

Symptoms of proximal femoral fracture vary depending on the exact location of the break. Bruising is often seen but, perhaps surprisingly, moving and placing weight on the leg does not always cause a lot of pain if the bone is still aligned. When sections of bone have been moved out of place, this is known as a displaced fracture. Even small movements typically cause pain and the leg will not bear weight. With a displaced fracture, the leg will look shorter than usual and may appear to be turned outward.

In most cases, a proximal femoral fracture can be diagnosed by its appearance on an X-ray. Treatment of proximal femoral fracture aims to relieve pain and enable patients to resume their usual activities. Usually, surgery is carried out to fix bone fragments together while they heal or to replace some or all of the hip joint with artificial parts.