Femoral Neck Fracture: Treatments and Complications

How Doctors Treat a Break In the Ball-and-Socket Hip Joint

A femoral neck fracture is one type of hip fracture. This injury occurs just below the ball of the ball-and-socket hip joint, the region of the thigh bone called the femoral neck. A femoral neck fracture disconnects the ball from the rest of the thigh bone (femur). Pain in the groin that worsens with pressure put on the hip is the most notable symptom.

Hip fractures are often thought of an older person's injury, but active younger people are also at risk because of falls, auto accidents, and overuse (stress fractures). Immediate treatment of a femoral neck fracture—or any hip fracture, for that matter—is essential to mitigating a host of possible complications.

Femoral neck.
 Getty Images / VOISIN / PHANIE

Complications and Concerns

The threat to future mobility and quality of life are obviously a factor when considering the impact of any hip fracture, but risk of death also rises dramatically after such an injury. Hip fractures are particularly dangerous for older adults.

Overall mortality rates hover at 6% during hospital treatment and 20% to 30% during the first year after injury (with highest rates during the first six months) due to immediate complications like infection and eventual lack-of-mobility issues like pneumonia and cardiovascular disease.

Prompt treatment is crucial. Some research has shown the mortality rate in elderly fracture patients rises when treatment is delayed more than 24 hours.

But femoral neck fractures in particular can be tricky because of the thinness of the bone in that area (which makes osteoporosis a contributing factor). In addition, the blood supply to the fractured portion of bone is often damaged at the time of injury, which impedes bone healing.

This disrupted blood flow to bone often results in osteonecrosis (avascular necrosis), the literal death of bone cells. This can lead to bone collapse in the area and end-stage arthritis in the hip joint.

Rating Fracture Severity

Physicians use what's known as the Garden classification system to rate the severity of a femoral neck fracture. There are four stages, or types, with type I being the least severe (an incomplete, non-displaced fracture; a partial break) and type IV being the most severe (a complete, fully-displaced fracture; bones are separated and out of alignment).

Doctors typically diagnose a femoral neck fracture via X-ray, particularly for type III and IV breaks. For subtler cases when an X-ray shows nothing and the patient still has symptoms (common with type I stress fractures, for example), more sensitive imaging tests like magnetic resonance imaging (MRI) or a bone scan may be ordered.

Having such a system to immediately define a femoral neck fracture helps doctors quickly determine the severity of the injury and a probable course of treatment.

Treatment of Femoral Neck Fracture

Surgery is the most common treatment for a femoral neck fracture, though conservative treatment could be warranted in high-risk cases or less-severe stress fractures. This could include resting the joint, keeping weight off the hip with crutches, pain management, and physical therapy after the bone has healed.

For surgical treatment, the most important criteria to consider include:

  • The severity of fracture displacement
  • Patient age

Surgery often brings good results. One review of 29 studies covering more than 5,000 hip fracture patients found that surgical treatment delivered higher rates of bone union (93% versus 69%) and lower rates of osteonecrosis (8% versus 10%) than nonsurgical, conservative treatments.

Open Reduction and Internal Fixation

Doctors manually re-align displaced bone and use surgical pins, screws, or nails to hold the bones in place.

Patients can generally place as much weight on the repaired hip as is tolerated, but this will vary in some cases. Check with your surgeon before initiating any therapy or exercise. As the bones heal, the pain should generally subside.

In cases where osteonecrosis sets in, patients may eventually require hip replacement surgery.

Partial or Full Hip Replacement

In hemiarthroplasty or total arthroplasty, the bones of the ball-and-socket joint are removed and replaced with metal or ceramic implants. Hip replacement is favored in patients with displaced fractures because of the complications of trying to repair these fractures.

However, in patients younger than 60, doctors will make every effort to avoid a partial hip replacement. Hip replacements work very well for less active patients, but they tend to wear out in younger, more active patients. Some data shows other surgical options work better in these individuals.

Rehabilitation begins immediately after a partial or full hip replacement, and patients can usually walk with their full weight on the implant. They tend to feel much better after the surgery and usually return to walking quite quickly.

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  2. Xu, D., Bi, F., Ma, C. et al. A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosisJ Orthop Surg Res 12, 28 (2017) doi:10.1186/s13018-017-0528-9

  3. Hu X, Liu BJ, Wen XM, Zheng YH, Jia K. [Clinical observation of closed reduction and compression cannulated screw fixation for the treatment of femoral neck fracture in young and middle-aged patients]. Zhongguo Gu Shang. 2018;31(2):111-114. doi:10.3969/j.issn.1003-0034.2018.02.003

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