An intracapsular fracture is a significant bone injury within a joint’s protective sac. Its location can compromise blood supply to the affected bone, leading to pain and impacting movement. Prompt medical attention is necessary for recovery.
What is an Intracapsular Fracture?
An intracapsular fracture is a bone break inside the joint capsule, containing synovial fluid for lubrication and nourishment. The most common site is the hip, specifically the femoral head or neck. The femoral neck connects the rounded head of the thigh bone (femur) to its shaft.
An intracapsular hip fracture significantly disrupts blood supply to the femoral head. Blood vessels supplying this area travel along the femoral neck and within the joint capsule. A fracture here can tear these vessels, leading to blood flow loss. This impacts bone healing and can lead to serious complications.
Intracapsular fractures are classified by displacement, or how much bone fragments have moved. Garden I-IV categories describe severity (incomplete to fully displaced). Undisplaced fractures are more stable, while displaced fractures carry a higher risk of complications, including blood supply damage.
Causes and Symptoms
Intracapsular fractures are frequently caused by falls, especially in older adults. A simple fall onto the hip’s side can cause such an injury. Risk is higher in individuals with weakened bones, often due to osteoporosis, which reduces bone density and makes bones brittle.
Older age is a key risk factor due to decreased bone density and increased fall likelihood. In younger individuals, these fractures result from high-energy trauma, such as car accidents or falls from heights. Certain medications, like bisphosphonates, increase risk with long-term use.
Common symptoms include severe hip or groin pain, worsening with movement or weight-bearing. Standing or walking is often impossible. The injured leg may appear shorter and turn outwards. Swelling and bruising around the hip or groin are common.
Diagnosis and Treatment Options
Diagnosis begins with imaging. An X-ray of the hip and pelvis is usually the initial test. If X-rays don’t clearly show a fracture (especially subtle or “occult” ones), an MRI scan may provide more detail. A CT scan helps classify the fracture pattern.
Surgery is almost always necessary to relieve pain and regain mobility. It is performed as soon as possible, ideally within 24 to 48 hours, to reduce complications. Before surgery, patients receive prophylactic antibiotics and venous thromboembolism prophylaxis.
Several surgical procedures are used, chosen based on patient age, health, and fracture displacement. For undisplaced fractures, internal fixation with screws or pins stabilizes bone fragments, preventing displacement during recovery.
For displaced intracapsular fractures, hip replacement surgery is often preferred. Hemiarthroplasty (partial hip replacement) replaces only the femoral head; total hip arthroplasty replaces both. Total hip replacement is often offered to independently mobile, medically fit patients before injury. Non-surgical management is rare, reserved for patients with severe medical conditions or those non-ambulatory.
Recovery and Long-Term Outlook
Recovery from an intracapsular fracture is a gradual process requiring rehabilitation. Physical therapy begins immediately after surgery, restoring mobility and strength to the affected hip and leg. Patients with hip replacement are encouraged to bear weight as tolerated early post-surgery.
Recovery timeline varies, but adherence to physical therapy is crucial for optimal functional recovery. Assistive devices like walkers or crutches are common in initial rehabilitation to support weight-bearing and aid safe movement. The program is tailored to individual needs, progressing from gentle range-of-motion to strengthening and balance training.
Despite surgical intervention, complications can arise. Avascular necrosis (AVN), or osteonecrosis, is a concern, particularly with displaced intracapsular fractures. This occurs when blood supply to the femoral head is compromised, leading to bone tissue death, pain, and eventual joint collapse. Non-union, where bone fragments fail to heal, is another complication, especially with internal fixation. Other issues include surgical site infection or deep vein thrombosis.
The long-term prognosis depends on initial treatment success and rehabilitation commitment. Many patients regain significant function and mobility, though some experience long-term pain or limitations. For older adults, hip fractures are associated with increased morbidity and mortality. Early surgical fixation and comprehensive postoperative care, including fall prevention and osteoporosis management, improve outcomes and help patients return to their pre-fracture functional level.