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A femoral neck fracture is a break in the bone that connects the ball of the thigh bone (femur) to the hip joint. These fractures are most common in older adults, especially those with osteoporosis, a condition that weakens bones. They can also occur in younger people as a result of a high-energy injury, such as a car accident or a fall from a height.
Femoral neck fractures are most common in older adults, especially women.
Here’s a breakdown of the demographics most susceptible to femoral neck fractures:
- Age: The risk of femoral neck fractures increases significantly with age. People over the age of 65 are much more likely to experience these fractures than younger individuals.
- Gender: Women are more likely than men to experience femoral neck fractures. This is partly due to the fact that women tend to have lower bone density than men, especially after menopause.
- Osteoporosis: This condition, which weakens bones, is a major risk factor for femoral neck fractures. It is more common in women, especially after menopause, and in older adults of both genders.
Other factors that can increase the risk of femoral neck fractures include:
- Previous fractures: People who have had a previous fracture are more likely to experience another one, including a femoral neck fracture.
- Certain medical conditions: Conditions such as rheumatoid arthritis and chronic use of corticosteroids can weaken bones and increase the risk of fractures.
- Poor balance and gait: Difficulty walking and maintaining balance can increase the risk of falls, which can lead to femoral neck fractures.
Symptoms of a femoral neck fracture can include:
- Severe pain in the hip or groin, which may worsen with movement
- Inability to bear weight on the affected leg
- Bruising and swelling around the hip
- Shortening of the affected leg
Treatment for a femoral neck fracture typically involves surgery. The type of surgery will depend on the severity of the fracture and the patient’s overall health. Common surgical options include:
- Internal fixation: This procedure involves using pins, screws, or plates to hold the fractured bones together.
- Hip replacement: This procedure involves replacing the damaged ball and socket of the hip joint with artificial parts.
Recovery from a femoral neck fracture can be a long process. It typically takes several months for the bone to heal completely. During this time, patients will need to undergo physical therapy to regain strength and mobility in their hip.
The choice of surgical method for treating a femoral neck fracture depends on several factors, including the severity and type of the fracture, the patient’s age and overall health, and the surgeon’s expertise. Here are the two main surgical approaches commonly used:
Internal fixation:
This minimally invasive procedure involves using cannulated screws to hold the fractured bones together.
- Screws are inserted through a small incision in the skin and guided into the bone using fluoroscopy (live X-ray imaging).
- This technique is preferred for younger patients with non-displaced fractures (where the bone fragments are still aligned).
Advantages of internal fixation include:
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- Minimally invasive, leading to faster recovery and less blood loss.
- Preserves the patient’s natural bone anatomy.
Disadvantages include:
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- Not suitable for all types of fractures, especially displaced or comminuted fractures (where the bone is broken into multiple pieces).
- There is a small risk of screw failure or malunion (improper healing).
Hip replacement:
This procedure involves removing the damaged bone and cartilage from the hip joint and replacing them with artificial components. There are two main types of hip replacement used for femoral neck fractures:
Hemiarthroplasty: This replaces only the ball of the femur (femoral head) with a metal implant.
Total hip arthroplasty: This replaces both the ball and socket of the hip joint with artificial components.
Hip replacement is typically recommended for:
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- Older patients with displaced fractures or medical conditions that make them poor candidates for internal fixation.
- Comminuted fractures where the bone is shattered into multiple pieces.
- Fractures that occur in patients with severe osteoporosis, as there is a higher risk of implant failure with internal fixation in these cases.
Advantages of hip replacement include:
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- Provides immediate pain relief and improved mobility.
- More durable and less prone to complications than internal fixation in certain situations.
Disadvantages include:
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- More invasive surgery with a longer recovery time.
- Increased risk of complications such as infection, dislocation, and loosening of the implant.
It’s important to note that the decision of which surgical technique is best for a particular patient should be made by an orthopedic surgeon after considering all the individual factors involved.
Surgical treatment is necessary for displaced intracapsular and all extracapsular fractures of the femoral neck.
The timing of surgery is important, especially in elderly patients with comorbidities. The risk of avascular (aseptic) necrosis increases within 12 hours of injury.
For non-dislocated fractures, in situ fixation is recommended to prevent displacement. Displaced femoral neck fractures are treated depending on the age and functional requirements of the patient. These fractures are at high risk for avascular necrosis (12% to 33%) and nonadhesion (15% to 33%). In healthy active patients, the treatment choice is anatomic repositioning with internal fixation.
Anatomically repositioned femoral neck fractures are best fixed with 3 AO screws.
In inactive or chronically ill patients, primary arthroplasty should be considered as the primary treatment method to avoid complications such as osteosynthesis failure or osteonecrosis.
Additional Surgical techniques
Screw fixation.
Stabilization of a femoral neck fracture can be done with open or percutaneous screws under x-ray control.
There are many different screws available, but the most commonly used are AO screws, either titanium or steel.
Good results can be expected after screw fixation of displaced femoral neck fractures. The outcome of displaced fractures is less predictable, making the treatment of these fractures more controversial.
In patients with osteoporosis, this type of helical osteosynthesis will be doomed to failure.
Any attempt to locate a varus deformity fracture is associated with an increased rate of avascular necrosis and nonunion. Particular attention should be paid to the degree of posterior wall fragmentation (lateral radiography).
In fractures with marked posterior wall fragmentation, they have a high incidence of nonadhesion. If screw placement within acceptable limits is not possible, then they should be abandoned and switched to arthroplasty.
Fixation with a DHS plate.
In certain types of fractures at the base of the femoral neck (base fracture), fixation is performed with a screw plate — the DHS plate .
Unipolar prosthesis.
Unipolar arthroplasty is performed in elderly patients with low functional requirements, widespread osteoporosis, or common diseases that make bone healing difficult. It has the advantage of allowing rapid loading of the joint.
Bipolar arthroplasty.
Suitable for high-dislocation subcapital fractures and for comorbidities such as rheumatoid arthritis and osteoarthritis, as well as in patients with Parkinson’s disease and other neuromuscular diseases.
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Femoral Neck Fracture Treatment with us
Experiencing severe hip pain or difficulty walking after a fall?
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Skilled and compassionate surgeons: Our surgeons are highly qualified and dedicated to providing individualized care, ensuring you receive the best possible outcome.
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Dedicated rehabilitation team: We work closely with a team of physical therapists to create a personalized rehabilitation program to help you regain your strength and mobility as quickly as possible.
Don’t delay seeking treatment. The sooner you receive care, the better your chances of a full recovery.
Contact us today for a consultation.