Introduction
The fracture of the femoral neck (syn. : femoral neck fracture) is one of the most common fractures in older people. A banal fall is sufficient in many cases as an accident mechanism.
As a result of reduced bone density in osteoporosis, the risk of such injuries increases. The neck of the femur is the connection between the head of the femur and the femoral shaft. The rapid stabilization of the fracture and, in particular, rapid mobilization after the accident is of great importance. Possible late consequences, such as femoral head necrosis, hip arthrosis or a difference in leg length can be counteracted with the help of adequate, early therapy.
Femoral head necrosis
A femoral head necrosis is also called post-traumatic femoral head necrosis and can occur as a late consequence of a fracture of the femoral neck. Reduced blood flow to the femoral head leads to the death of bone tissue. Causes of femoral head necrosis can be alcoholism and metabolic disorders.
If the bone tissue is insufficiently supplied with oxygen over a longer period of time, it demineralizes and dies. The blood supply to the femoral head and neck is ensured by the circular arteria circumflexa. In about one-fifth of cases, the arteria capitis femoris additionally supplies the femoral head.
The vessels form numerous connections, so-called anastomoses, and communicate with each other in this way. If several of the vascular connections are interrupted, safe blood flow to the head of the femur is no longer guaranteed. In particular in fractures near the femoral head with severe displacement of the fragments and when the femoral neck fracture is screwed together, there is an increased risk of the development of femoral head necrosis.
Certain factors also favour the occurrence of femoral head necrosis. These include smoking, elevated blood lipid levels and increased alcohol consumption. Osteoarthritis of the hip is a common consequence of necrosis if it remains untreated.
In the early stages of the disease, diagnosis is difficult. It is usually a process that takes years. The early symptoms include unspecific pain in the groin and hip joint.
In addition, movement restrictions in internal rotation and extension occur in the hip joint. Diagnostically, the first signs of reduced metabolism can only be detected by means of an MRI examination. At this point, timely treatment can be initiated. After collapse of the femoral head, significantly stronger pain occurs. It is often no longer possible to preserve the femoral head.
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