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A femoral neck fracture is a type of hip fracture of the thigh bone (femur)—just below the ball of the ball-and-socket hip joint. This type of fracture disconnects the ball from the rest of the femur. It often causes groin pain that worsens when you put weight on the injured leg.
Hip fractures are more common among older people, but they can occur occasionally in active younger people due to falls, auto accidents, and occasionally stress fractures related to overuse. Immediate treatment of a femoral neck fracture—or any hip fracture, for that matter—is essential to mitigating possible complications. The treatment is typically surgery, with physical therapy afterward.
A femoral neck fracture can be particularly serious because of a possible complication: It can cut off the blood supply to the head of the thighbone. People with femoral neck fractures are typically advised to stop putting any weight on the affected hip—so that the hip doesn't dislocate. This affects activities such as walking, using the restroom, and even sleeping.
This article will discuss possible complications of femoral neck fractures, as well as what happens when you experience a femoral neck fracture, from diagnosis to treatment to recovery. It will also cover some ways you can prevent a femoral neck fracture.
Mobility and quality of life are important factors when considering the impact of any hip fracture. Severe osteoarthritis can result after this type of fracture. Hip fractures are particularly dangerous for older adults.
Among older adults, the risk of death rises dramatically after sustaining such an injury. Overall mortality rates hover at 6% during hospital treatment and 20–30% during the first year after injury (with the highest rates during the first six months). Mortality can occur due to immediate complications like infection, or due to delayed complications due to lack of mobility—such as pneumonia and cardiovascular disease.
If people don't get treatment for their femoral neck fractures, they may need to stay in a chair or in bed for a few months, avoiding putting any weight on the hip. This can cause them to decline both physically and mentally.
Prompt treatment of a hip fracture is crucial. Some research has shown the mortality and complication rates in elderly fracture patients can be better when surgery is done within 48 hours.
Femoral neck fractures can be complicated because the bone in that area is thin. And osteoporosis is often a contributing factor. In addition, the blood supply to the fractured portion of bone can be damaged at the time of injury, which impedes bone healing.
Disrupted blood flow to bone often results in osteonecrosis, a condition in which the bone cells die due to a lack of blood flow. This can lead to bone collapse in the area of injury.
Symptoms of a femoral neck fracture are the same as those of hip fractures in general—as well as other medical conditions. A healthcare provider can confirm the fracture and determine what type it is. If you've fractured your hip, you may experience the following:
Your healthcare provider can usually diagnose a femoral neck fracture with a hip X-ray. In some cases, such as with a stress fracture, you might have symptoms, but your X-ray might not show significant findings. The fracture would likely be visible with a computerized tomography (CT) scan, magnetic resonance imaging (MRI), or a bone scan.
The Garden classification system is used 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).
Your medical team will use this classification as they consider the most effective course of treatment for your fracture.
Surgery is the most common treatment for a femoral neck fracture, though conservative management could be the best approach if surgery would be a very high risk for you or if you have a less-severe stress fracture.
Conservative treatments could include resting your hip joint, keeping weight off your hip with crutches, pain management, and physical therapy after the bone has healed. These approaches are rarely used instead of surgery.
For surgical treatment, the most important criteria include:
During your surgery, your surgeon would manually re-align your displaced bone and use surgical pins, screws, or nails to hold your bones in place while they heal.
There are several factors that determine whether you can place weight on your repaired hip. Check with your surgeon before initiating any physical therapy or exercise. As your bones heal, your pain should generally improve.
If you develop osteonecrosis, you may eventually need to have hip replacement surgery.
In a hemiarthroplasty (partial hip replacement) or total arthroplasty, the bones of the ball-and-socket joint are removed and replaced with metal or ceramic implants. Hip replacement may be favored if you've had a displaced fracture because of the complications and healing rates associated with surgical repair of these types of fractures.
In younger patients, surgeons will make an effort to avoid a partial hip replacement, if possible. Hip replacements work very well for less active patients, but they tend to wear out in younger, more active patients. Some data shows that other surgical options work better in these individuals.
Rehabilitation typically begins immediately after a partial or full hip replacement. Many patients can progress quickly to walking with their full weight on the implant as their pain improves.
You'll likely remain in the hospital after surgery for three to five days. There, you may be given compression stockings to improve your leg's blood flow, as well as pain relievers and antibiotics to prevent infections. You may need to have a catheter inserted to drain urine for two to three days after the surgery—until you can start urinating on your own.
Despite being in the hospital, you'll be encouraged to move and walk as soon as possible, usually on the first day after the surgery. Staying active can help prevent complications of hip fracture surgery.
You will likely be given crutches or a walker at the hospital, which you may need to use for a few weeks to a few months after the surgery. Your healthcare provider or physical therapist can let you know when you can stop using the supports.
Physical therapy is recommended after femoral neck fracture surgery, beginning while you're in the hospital. Your physical therapist can also share some tips for a hazard-free home setup. You will likely need help around the home for the first one to two weeks after the surgery.
Whether you're recovering from a femoral neck fracture or are at risk for one due to your age, here are some ways you can set up your home to avoid falling hazards:
You can also adopt lifestyle changes that keep your bones strong and prevent another fracture. These include:
Additionally, it's best to avoid staying in bed or a chair for a long time as it can cause pressure sores. It's also important to get your hearing and eyesight checked annually as you get older.
A femoral neck fracture is a type of hip fracture. It can come with some complications, so prompt treatment, typically with surgery, is essential.
Setting up your home to avoid falling hazards is important to prevent a femoral neck fracture, especially if you are at risk due to your age. To keep bones strong, try avoiding smoking, maintaining a diet rich in vitamin D and calcium, and exercising in a way that puts weight on the hip (e.g. walking or jogging).
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By Jonathan Cluett, MD
Dr. Cluett is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the U.S. national soccer teams.
