A fall onto the hip is usually harmless for young people, but in older patients it often leads to a femoral neck fracture. This fracture at the upper end of the thigh bone—known medically as the femur—is one of the most common injuries among the elderly. Compounded by osteoporosis, even a minor impact is often enough to cause the femoral neck to fracture. Such a femoral fracture usually results in immediate immobility and severe pain for those affected. Since the blood supply to the femoral head may be compromised and prolonged bed rest carries risks such as thrombosis or pneumonia, prompt surgery is almost always necessary. Whether the joint can be preserved or must be replaced depends on the exact location of the fracture and the blood supply to the area.
How common are femoral neck fractures?
Nearly 100,000 people suffered a femoral neck fracture in 2007. Most of them required surgery as a result.
More than 45 percent of these patients were over 80 years old, and the majority were women. This clearly shows that a femoral neck fracture is a typical injury among older adults, especially older women.
Fifty years ago, a femoral neck fracture in an older person almost always led to bedridden status and, shortly thereafter, to death. Since then, the situation has changed in favor of patients. Today, surgical methods are available that can usually prevent bedridden status.
What causes a femoral neck fracture?
A femoral neck fracture is usually the result of a fall. Very often, those affected have osteoporosis, a condition that causes bones to become more porous and thus less stable. This is also referred to as bone loss.
Osteoporosis occurs primarily in older adults, and women are affected significantly more often than men. The bones of people with osteoporosis break much more easily than healthy bones. For this reason, even a minor fall is often enough to cause a femoral neck fracture.
What are the symptoms of a femoral neck fracture?
Symptoms of a femoral neck fracture include pain in the hip and groin area. Those affected are also unable to put weight on their hip.
The affected leg appears shorter than the other and is turned outward (external rotation deformity).
Surgical Treatment of a Femoral Neck Fracture
After a fall and a diagnosis of a femoral neck fracture, the patient should undergo surgery as soon as possible.
Most patients then receive an artificial hip joint, a hip endoprosthesis. This hip prosthesis allows them to get out of bed immediately after surgery and put their full weight back on the previously injured leg. Initially, the patient will need crutches to do so.
The hospital stay is usually short; patients spend about 2 weeks in the hospital. This is followed by physical therapy.
After Surgery for a Femoral Neck Fracture
Patients often undergo rehabilitation following hip joint surgery. For this reason, trauma surgeons and geriatricians work closely together in the care of older adults. The goal of this collaboration is to enable patients to return to an independent lifestyle. Patients should return to the familiar surroundings of their own home as soon as possible.
As a result, hospitalization following a femoral neck fracture often concludes with a gradual transition from the hospital—for example, to a geriatric day clinic. There, a gradual return to their normal daily routine can be facilitated.
Even when there are no medical complications, 20 percent of patients still die within the first year following a femoral neck fracture. The reasons for this are not yet clear. This phenomenon is observed not only in Germany but throughout Central and Western Europe as well as in North America.
Doctors and health insurance companies are conducting intensive research on this issue.
Findings on Femoral Neck Fractures
Today, a femoral neck fracture remains a serious injury. However, the orthopedic and geriatric challenges it presents are manageable.
Very few people now die in the hospital as a result of a femoral neck fracture. Complications after surgery are also rare.
Prevention of femoral neck fractures
If osteoporosis is detected early, its progression can be slowed with
- exercise,
- age-appropriate exercise, and
- medication
. In many cases, however, osteoporosis is not diagnosed until a femoral neck fracture or other fractures have already occurred.
A new tendency to fall due to dizziness must also be evaluated immediately by your primary care physician. This offers the chance to reduce the frequency of falls, if possible.
FAQ: The 8 Most Important Questions About Femoral Neck Fractures
How can you recognize a femoral neck fracture?
Typical symptoms include severe pain in the groin and hip area, making any movement impossible. The affected leg is often visibly shorter and is in an external rotation position, as the muscles pull the thigh upward and rotate it due to the fracture. It is no longer possible to bear weight on or lift the leg. However, in the case of impacted fractures, the symptoms may be milder, so that some patients are still able to walk, which makes diagnosing a femoral neck fracture without an X-ray more difficult.
What is the difference between a medial and a lateral fracture?
The classification is based on the location of the fracture relative to the attachment of the joint capsule. A medial femoral neck fracture occurs within the joint capsule (intracapsular) and is the most common type. Since the vascular layers run through this area, blood supply to the femoral head is often compromised, which can increase the risk of avascular necrosis of the femoral head. A lateral femoral neck fracture is located further out, usually outside the joint capsule (extracapsular), and has a better prognosis in terms of blood supply, but is more prone to osteoarthritis due to malalignment.
How is a femoral neck fracture treated?
Treatment for a femoral neck fracture is usually surgical. The goal is a stable repair that allows for immediate mobilization. In younger patients, an attempt is made to preserve the femoral head by stabilizing the fracture using osteosynthesis (screw fixation or a dynamic hip screw). In older patients with poor bone quality or a high risk of femoral head necrosis, a hip replacement is usually implanted to replace the femoral head and, if necessary, the acetabulum.
Why is it necessary to operate so quickly?
Guidelines and studies, as discussed in the *Deutsches Ärzteblatt*, recommend surgical treatment within 24 hours of the accident. Prompt treatment drastically reduces the complication rate, as prolonged bed rest in older patients can quickly lead to pressure ulcers, pneumonia, or thrombosis. Furthermore, in the case of a medial fracture, the risk of the femoral head becoming necrotic increases with every hour that passes if reduction and fixation are not performed promptly.
What complications can occur?
In addition to general surgical risks, femoral head necrosis is a specific complication of a femoral neck fracture, in which the bone tissue of the femoral head dies due to insufficient blood flow. Pseudarthrosis—that is, failure of the bone to heal properly—can also occur after osteosynthesis. In the case of displaced fractures, where the bone ends have shifted, there is also a risk of osteoarthritis or re-dislocation, which may require a second surgery.
What does postoperative care involve?
Rehabilitation begins on the very first day after surgery. Physical therapy exercises are designed to promote rapid mobilization in order to strengthen the muscles and restore mobility in the hip joint. When a prosthesis is implanted, full weight-bearing is usually permitted immediately, which is essential for maintaining independence. Follow-up X-rays are performed to check the fit of the implants and ensure that no sintering (sagging) of the femoral neck occurs.
What is an adduction fracture?
This refers to the Pauwels classification, which describes the angle of the fracture. An adduction fracture (Pauwels III) has a steep fracture line, which leads to high shear forces. These fractures are unstable and heal poorly with conservative treatment, which is why they almost always require surgical intervention—either osteosynthesis or a prosthesis—to prevent varus deformity of the femoral neck and pseudarthrosis.
What is the life expectancy after a femoral neck fracture?
Unfortunately, statistics show that mortality is elevated in the first year following the injury. Approximately 20 to 30 percent of patients with a femoral fracture die within one year, often not directly from the fracture itself, but from the consequences of immobility and comorbidities. A comprehensive treatment approach combining surgery, geriatrics, and early rehabilitation is crucial for maintaining quality of life and preventing further femoral neck fractures.
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