Neck of femur fracture

The hip is a ball-and-socket joint where the head of the thigh bone (femur) acts as a ball that fits into the rounded socket of the hip bone (acetabulum). The neck of the femur is the region just below the ball of the hip joint.

A femoral neck fracture is a particular type of hip fracture that occurs at the femoral neck. When a femoral neck fracture occurs, the ball is essentially disconnected from the rest of the femur. Fractures to the femoral neck can completely or partially disconnect the femoral head from the rest of the femur. Femoral neck fractures may be displaced, where the bone is moved out of its original position, or non-displaced, where there is no instability of the bone.

With femoral neck fractures, the blood supply to the fractured portion of bone is often damaged. When blood flow is disrupted, fractures are at high risk of incorrect healing, especially when the fracture is significantly out of position. Due to this blood supply problem with femoral neck fractures, the recommended treatment is often a partial hip replacement.

Common symptoms

  • Radiating pain in 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 may involve:

  • Medical history review
  • Physical examination
  • MRI
  • X-ray

Procedures for fixation

Treatment of a femoral neck fracture depends on several factors and can be fixed in a number of ways, such as with a short gamma nail, long gamma nail or partial replacement (hemiarthroplasty).

Important factors include the amount of displacement of the fracture and the age of the patient. Usually with patients under 60 years old, every effort is made to avoid a partial hip replacement. Hip replacements can work very well for less active patients, but they tend to wear out in more active patients.

A hip hemiarthroplasty is half of a total hip replacement. In this procedure, the ball of the ball-and-socket joint is removed, and a metal implant is inserted into the joint. Hip hemiarthroplasty is more suited to patients with displaced fractures because of the potential complications with trying to repair these fractures.

The procedure is performed under general anesthesia or spinal anesthesia. An incision is made over the outside of the hip. The fractured femoral head is removed, and replaced with a metal implant. In most cases of femoral neck fractures, the socket is left as it is.

Post operative

Rehabilitation is initiated immediately and patients can usually walk with their full weight on the implant. Patients tend to feel much better after the surgery, and usually return to walking quite quickly.

Any ongoing pain can be managed with medicines and physical therapy will help you to regain the motion and strength of your hip joint. The duration of your therapy will depend on several factors, including your age and overall fitness.

Prognosis

Brief episodes of pain and/or stiffness are common after a hemiarthroplasty. However, prolonged discomfort in your replaced hip should not be expected. If the operation is successful, there are no complications and you follow your physical therapy plan, your new hip should give you long and healthy usage. Strengthening exercises may be required for up to a year after surgery and you may have to permanently avoid or reduce activities that require heavy lifting, climbing or running.