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Skeletal Radiol. 2019 Jan;48(1):29-45. doi: 10.1007/s00256-018-3008-3. Epub 2018 Jun 29.

Fragility fractures of the proximal femur: review and update for radiologists.

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Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA.
Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, 98105, USA.


Proximal femoral fragility fractures are common and result in significant morbidity and mortality along with a considerable socioeconomic burden. The goals of this article are to review relevant proximal femoral anatomy together with imaging, classification, and management of proximal femoral fragility fractures, and their most common complications. Imaging plays an integral role in classification, management and follow-up of proximal femoral fragility fractures. Classification of proximal femoral fragility fractures is primarily based on anteroposterior hip radiographs. Pertinent imaging features for each category of proximal femoral fractures that would guide management are: differentiating nondisplaced from displaced femoral neck fractures, distinguishing stable from unstable intertrochanteric fractures, and determining the morphology and comminution of subtrochanteric fractures. Treatment of proximal femoral fragility fractures is primarily surgical with either arthroplasty or internal fixation. Intramedullary nailing is used in the treatment of some types of proximal femoral fragility fractures and may be associated with unique complications that become evident on postoperative follow-up radiographs.


Cephalomedullary nail; Femoral neck fracture; Fragility fracture; Hip fracture; Intertrochanteric fracture; Intramedullary nail; Proximal femur fracture; Sliding hip screw; Subtrochanteric fracture

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