Introduction
The hip is a ball-and-socket joint made up of the head of the thigh bone or femur that acts as the ball and fits into the rounded socket of the hip bone or acetabulum. The neck of the femur is the region just below the ball of the hip joint.
Fractures to the femoral neck can completely or partially disconnect the femoral head from the rest of the femur. Femoral neck fractures may be either displaced, where the bone is moved out of its original position, or non-displaced, where there is no instability of the bone. These fractures may disrupt the blood supply to the fractured portion of the bone. In cases of badly displaced femoral neck fractures, the decreased blood supply prevents these fractures from healing.
Causes
Femoral neck fractures can occur with
- A minor fall or twisting of the hip in the elderly
- Patients with osteoporosis
- High-impact trauma such as motor vehicle accidents
- Younger individuals unaccustomed to sudden strenuous activity or change in activit
Signs and Symptoms
The symptoms of a femoral neck fracture include:
- Radiating pain to the knee
- Inability to bear weight
- Shortening or sideways rotation of the affected leg
- Increased pain in the hip during rotation of the leg
- Swelling on the side of the hip
Diagnosis
Femoral neck fractures are diagnosed based on physical examination, your symptoms and circumstances of the accident.
Your doctor will order an X-ray to diagnose a femoral neck fracture. Your doctor may also perform other imaging tests such as the magnetic resonance imaging (MRI), and computer tomography (CT) scan to obtain further information.
Radiographic image of a broken Shenton's curve, which shows the relationship of the femoral head to the acetabulum, indicates a femoral neck fracture.
Treatment
Treatment of a femoral neck fracture will depend on your age and the extent of displacement of the fractured bone.
Conservative therapeutic approaches are suggested for uncomplicated fractures and include bed rest for a few days followed by a physical rehabilitation program after 2 or 3 days. Your doctor may also prescribe medications to prevent blood clots, relieve pain and treat any infection that may be present.
However, femoral neck fractures are rarely stable enough to manage with only conservative therapy and usually require surgical repair.
Surgery for a femoral neck fracture is performed under general or spinal anesthesia.
Hip pinning is recommended if your facture is minimally displaced and you have sufficient bone density. Your surgeon will make a small incision on the outside of your thigh and insert several screws to stabilize the broken bones.
Hip hemiarthroplasty or partial hip replacement is suggested if you have a displaced fracture. For this surgery, your surgeon will make an incision over the outside of the hip, remove the femoral head and replace it with a metal implant. The socket will not be replaced in a partial hip replacement procedure.
Total hip replacement is recommended if you have had arthritis of the hip before the fracture. Your surgeon will replace the femoral head as well as the socket of the hip joint with artificial metal implants.