Complications | Femoral neck fracture causes, diagnosis and treatment

Complications

Complications in surgical therapy of femoral neck fracture:

• Vascular, tendon and nerve injuries
• Thrombosis/pulmonary embolism
• Infection
• Slipping of the fracture
• Implant loosening
• False joint formation (pseudarthrosis)
• Femoral head necrosis

Aftercare Prognosis

Postoperative early mobilization is an absolute must for the mostly older patients. For this reason, mobilization begins with standing at the bed already on the 1st postoperative day. Subsequently, the operated leg may only be partially loaded (15-20 kg) for a period of 6-12 weeks in case of DHS.

The inserted metal (osteosynthesis material) can be removed after one to two years, if necessary not at all. Full weight bearing is achieved after about 3 months. Regular X-ray checks document the progressing healing of the fracture.

If a hip prosthesis is implanted, a higher load may be applied immediately. Depending on the choice of implant and the bone substance, full weight-bearing is sometimes possible immediately. A fracture of the femoral neck can also have some late consequences.

and pain after hip surgeryAfter surgical treatment of a fracture of the femoral neck, implant removal, i.e. removal of the osteosynthesis material (screws), is not absolutely necessary in all cases. Certain screw systems can also remain in the bone. A high patient age can also be a reason for leaving a screw in place.Overall, in addition to the age and choice of implant, the patient’s level of activity and possible local complaints in the hip region influence the decision to remove the screws.

In most cases, however, an implanted screw system is removed after about 2 years. The removal of the screws is carried out when the patient is hospitalized. This is a procedure that requires more exposure and the risk of complications is too high to be performed on an outpatient basis.

Implant removal is necessary because if left in place there may be an increased risk of certain complications. For example, fatigue fractures of the implant or infections may occur. In addition, an endoprosthetic treatment of another injury near the implant may be difficult.

Finally, the implant may become adhesions, so the time for screw removal must be chosen in good time. As with almost every surgical procedure, the risks during removal are the risk of nerve, vascular and soft tissue injury. There can also be heavy bleeding and infections.

After each removal, an X-ray check must be performed to ensure that no screw remains and that no new fractures have occurred as a result of the explantation. It is very important to come in for regular wound check-ups and, in the form of physiotherapy, to strive to restore full resilience and functionality. As already after the operation with treatment of the femoral neck fracture with osteosyntheses such as the screw, the patient should be mobilized quickly.

Patients are also prescribed physiotherapy. Since the risk of thrombosis is increased after such an operation, every patient receives a drug prophylaxis against thrombosis for a certain period of time. In comparison to the length of stay after surgery for initial treatment (several weeks), patients can leave the hospital after a few days if the screw removal is carried out without complications. Although full weight bearing is expected soon, patients should use crutches in the first few days to relieve pressure.